1619413747 NPI number — COUNSELING TO EMPOWERMENT PLLC

Table of content: (NPI 1619413747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619413747 NPI number — COUNSELING TO EMPOWERMENT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING TO EMPOWERMENT 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:
6
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:
1619413747
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 S FORT HOOD STREET
Provider Second Line Business Mailing Address:
SUITE 103B
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76542-1680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-239-1029
Provider Business Mailing Address Fax Number:
254-200-2453

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 S FORT HOOD STREET
Provider Second Line Business Practice Location Address:
SUITE 103B
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76542-1680
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-239-1029
Provider Business Practice Location Address Fax Number:
254-200-2453
Provider Enumeration Date:
01/12/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
254-239-1027

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC 58845 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC 58845 , 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: 288739001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 288739002 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 368414401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 368414402 . This is a "CHSCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3684144 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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