MEDICARE: VAST COUNSELING SERVICES, 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

General Provider Information

NPI Number	:	1811464852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAST COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	505 N SAM HOUSTON PKWY E STE 540
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4043
Country	:	US
Telephone Number	:	713-516-3527
Fax Number	:	832-458-0622

Provider Business Practice Location Address
First Line	:	505 N SAM HOUSTON PKWY E STE 540
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4043
Country	:	US
Telephone Number	:	713-516-3527
Fax Number	:	832-458-0622

Authorized Official
Title or Position	:	OWNER
Name	:	CAROL J NUNN
Credential	:	LPC, LCDC
Telephone Number	:	713-516-3527

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	10/29/2018

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