MEDICARE: HENNEBURG COUNSELING CENTER, P. C.

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center	2088-A	TX
2	101YM0800X	Mental Health Counselor	13071	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	:	1396874103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENNEBURG COUNSELING CENTER, P. C.

Provider Business Mailing Address
First Line	:	6090 SURETY DRIVE
Second Line	:	SUITE 105
City	:	EL PASO
State	:	TX
Zip	:	79905-2060
Country	:	US
Telephone Number	:	915-778-3807
Fax Number	:	915-779-6600

Provider Business Practice Location Address
First Line	:	6090 SURETY DRIVE
Second Line	:	SUITE 105
City	:	EL PASO
State	:	TX
Zip	:	79905-2060
Country	:	US
Telephone Number	:	915-778-3807
Fax Number	:	915-779-6600

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	MS. ESTEFANIA VENEGAS
Credential	:
Telephone Number	:	915-778-3807

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/06/2014

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Directions to “HENNEBURG COUNSELING CENTER, P. C. ” Practice Location

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