Healthcare Provider Details

I. General information

NPI: 1619871746
Provider Name (Legal Business Name): COVENANT OF PEACE CHRISTIAN COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 33166
AUSTIN TX
78731-4257
US

IV. Provider business mailing address

5900 BALCONES DR STE 33166
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 832-621-3536
  • Fax: 832-324-6985
Mailing address:
  • Phone: 832-621-3536
  • Fax: 832-324-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RICKEENA GRESHAM
Title or Position: OWNER
Credential: LPC
Phone: 832-621-3536