MEDICARE: JJJ COUNSELING & ASSOCIATES, 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	101YP2500X	Professional Counselor	71286	TX

General Provider Information

NPI Number	:	1811441165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJJ COUNSELING & ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 691
Second Line	:
City	:	EULESS
State	:	TX
Zip	:	76039-0691
Country	:	US
Telephone Number	:	817-913-0419
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S 14TH ST
Second Line	:	SUITE 140
City	:	MIDLOTHIAN
State	:	TX
Zip	:	76065-3358
Country	:	US
Telephone Number	:	817-913-0419
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MS. JESSICA GURAL
Credential	:	LPC, LCDCI
Telephone Number	:	817-913-0419

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	12/01/2016

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