MEDICARE: JIREH 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1972378768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JIREH COUNSELING CENTER PLLC

Provider Business Mailing Address
First Line	:	2000 25TH AVE N STE 103
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-5280
Country	:	US
Telephone Number	:	720-351-8424
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 25TH AVE N STE 103
Second Line	:
City	:	TEXAS CITY
State	:	TX
Zip	:	77590-5280
Country	:	US
Telephone Number	:	720-351-8424
Fax Number	:	409-440-8520

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MR. VERDALE GOINS
Credential	:	PHD, LPC
Telephone Number	:	720-351-8424

Provider Enumeration Date	:	11/21/2023
Last Update Date	:	11/28/2023

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