Healthcare Provider Details

I. General information

NPI: 1194800276
Provider Name (Legal Business Name): LETA ACKER, MA, PC AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 S KENTUCKY ST BLDG. D SUITE 260
AMARILLO TX
79102-2252
US

IV. Provider business mailing address

1616 S KENTUCKY ST BLDG. D SUITE 260
AMARILLO TX
79102-2252
US

V. Phone/Fax

Practice location:
  • Phone: 806-468-8900
  • Fax: 806-468-8902
Mailing address:
  • Phone: 806-468-8900
  • Fax: 806-468-8902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LETA ACKER
Title or Position: PRESIDENT
Credential: LPC, LMFT
Phone: 806-468-8900