MEDICARE: TEXAS ONLINE COUNSELING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023576055
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS ONLINE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	2023 W RANCH RD
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-5029
Country	:	US
Telephone Number	:	888-317-7021
Fax Number	:	888-317-7021

Provider Business Practice Location Address
First Line	:	926 WITHERBY LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4477
Country	:	US
Telephone Number	:	888-317-7021
Fax Number	:	888-317-7021

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MICHELLE INAUEN
Credential	:	MA., LPC AND LMFT
Telephone Number	:	888-317-7021

Provider Enumeration Date	:	03/08/2019
Last Update Date	:	03/08/2019

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Directions to “TEXAS ONLINE COUNSELING PLLC ” Practice Location

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