1699076026 NPI number — PROFESSIONAL COUNSELING SERVICES OF NETX

Table of content: KEITH LLOYD WEIN D.C. (NPI 1437119336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699076026 NPI number — PROFESSIONAL COUNSELING SERVICES OF NETX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROFESSIONAL COUNSELING SERVICES OF NETX
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:
1699076026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 48
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75452-0048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-268-3878
Provider Business Mailing Address Fax Number:
903-587-3101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 S. MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEONARD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75452-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-268-3878
Provider Business Practice Location Address Fax Number:
903-587-3101
Provider Enumeration Date:
11/17/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
LICENSED PROFESSIONAL COUNSELOR
Authorized Official Telephone Number:
903-268-3878

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X , with the licence number:  14952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 102L00000X , with the licence number: 17360 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 14952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: 17360 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 14952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 17360 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 14952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 17360 , 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: 17360 , 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: 14952 , 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: 216240602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 216240601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".