MEDICARE: ETSAH COUNSELING CENTER, 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	251S00000X	Community/Behavioral Health Agency
2	101YM0800X	Mental Health 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	:	1427591320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ETSAH COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	200 W STATE HIGHWAY 6 STE 217
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3975
Country	:	US
Telephone Number	:	254-447-4539
Fax Number	:	254-237-5369

Provider Business Practice Location Address
First Line	:	3500 HILLCREST DR STE 2B
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76708-3100
Country	:	US
Telephone Number	:	254-447-4539
Fax Number	:	254-237-5369

Authorized Official
Title or Position	:	OWNER
Name	:	NTIENSE COVEY
Credential	:	LCSW
Telephone Number	:	254-230-8501

Provider Enumeration Date	:	11/24/2016
Last Update Date	:	12/02/2024

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