MEDICARE: PARK TEN COUNSELING, INC.

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	101YM0800X	Mental Health Counselor	9588	TX
2	101YM0800X	Mental Health Counselor	002983-041991	TX
3	101YA0400X	Addiction (Substance Use Disorder) Counselor	1652	TX

General Provider Information

NPI Number	:	1699765537
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK TEN COUNSELING, INC.

Provider Business Mailing Address
First Line	:	414 GOVERNORS PLACE DR
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77450-1442
Country	:	US
Telephone Number	:	281-578-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	16350 PARK TEN PL
Second Line	:	SUITE 100-22
City	:	HOUSTON
State	:	TX
Zip	:	77084-5146
Country	:	US
Telephone Number	:	281-578-5838
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST/ PRESIDENT
Name	:	MR. FRANK LEO SIMCIK
Credential	:	M.ED.
Telephone Number	:	281-578-5838

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	09/10/2007

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