1477829026 NPI number — FAMILY & PASTORAL COUNSELING CENTER PLLC

Table of content: (NPI 1477829026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477829026 NPI number — FAMILY & PASTORAL COUNSELING CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY & PASTORAL COUNSELING CENTER PLLC
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:
1477829026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2629 PLAZA PKWY
Provider Second Line Business Mailing Address:
SUITE A-3
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76308-3885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-386-9378
Provider Business Mailing Address Fax Number:
940-386-9379

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2629 PLAZA PKWY
Provider Second Line Business Practice Location Address:
SUITE A-3
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76308-3885
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-386-9378
Provider Business Practice Location Address Fax Number:
940-386-9379
Provider Enumeration Date:
03/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SWINHOE
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
LMFT/OWNER
Authorized Official Telephone Number:
940-386-9378

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2381 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8070BH . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 028939901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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