MEDICARE: SHIELD-BEARER COUNSELING CENTERS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1114275534
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIELD-BEARER COUNSELING CENTERS

Provider Business Mailing Address
First Line	:	12345 JONES RD
Second Line	:	STE 285
City	:	HOUSTON
State	:	TX
Zip	:	77070-4958
Country	:	US
Telephone Number	:	281-894-7222
Fax Number	:

Provider Business Practice Location Address
First Line	:	12345 JONES RD
Second Line	:	STE 285
City	:	HOUSTON
State	:	TX
Zip	:	77070-4855
Country	:	US
Telephone Number	:	281-894-7222
Fax Number	:	281-894-7892

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ROY WOOTEN
Credential	:	M.S.
Telephone Number	:	281-894-7222

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	08/15/2012

Similar Medicare Providers

1811998420 — DR. RICHARD EARLE PALMER JR. M.D.
Practice Location Address:

12345 JONES RD , STE. 101
HOUSTON, TX
77070-4855

Practice Phone: 281-469-2181
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1477538833 — MRS. NANCY LYNN EISENBERG MSW, LCSW, LMFT
Practice Location Address:

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1922114636 — DR. LINDA BOWEN PH.D.
Practice Location Address:

12345 JONES RD , SUITE 260
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77070-4855

Practice Phone: 281-955-6011
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1538216312 — HORIZON EVALUATORS INC.
Practice Location Address:

12345 JONES RD , 110
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1114050861 — MARIA ALVARADO LPC
Practice Location Address:

12345 JONES RD , SUITE 110
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1972636660 — GLORIA JEAN WALKER LPC
Practice Location Address:

12345 JONES RD , SUITE 110
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1083747679 — CYNTHIA POWELL LPC
Practice Location Address:

12345 JONES RD , SUITE 110
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77070-4855

Practice Phone: 281-477-6363
Practice Fax: 281-477-6356

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