MEDICARE: ROLLINS COUNSELING LLC

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	101YP2500X	Professional Counselor	17334	TX

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	:	1205012788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROLLINS COUNSELING LLC

Provider Business Mailing Address
First Line	:	2801 REGAL RD
Second Line	:	SUITE 105
City	:	PLANO
State	:	TX
Zip	:	75075-6315
Country	:	US
Telephone Number	:	214-868-0016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 REGAL RD
Second Line	:	SUITE 105
City	:	PLANO
State	:	TX
Zip	:	75075-6315
Country	:	US
Telephone Number	:	214-868-0016
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. PAULETTE R ROLLINS
Credential	:	LPC, NCC
Telephone Number	:	214-868-0016

Provider Enumeration Date	:	01/15/2008
Last Update Date	:	01/15/2008

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