1750324414 NPI number — THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.

Table of content: (NPI 1750324414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750324414 NPI number — THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750324414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-2399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-353-1668
Provider Business Mailing Address Fax Number:
806-353-1668

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 W 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79101-2399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-353-1668
Provider Business Practice Location Address Fax Number:
806-353-1668
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOOLSEY
Authorized Official First Name:
TWILLA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
806-353-1668

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 096093203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121937006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148080802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290635601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177927401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 205124501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 028342601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030722501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161995901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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