1699076026 NPI number — PROFESSIONAL COUNSELING SERVICES OF NETX

Table of content: (NPI 1699076026)

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:
PROFESSIONAL COUNSELING SERVICES OF NETX
Provider Other Organization Name Type Code:
3
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: 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: 14952 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • 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: 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" .

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".




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