Healthcare Provider Details

I. General information

NPI: 1093348443
Provider Name (Legal Business Name): SOUTHEAST TEXAS COUNSELING & ASSESSMENT SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CALDER ST STE 204
BEAUMONT TX
77702-1926
US

IV. Provider business mailing address

11126 GAULDING RD
BEAUMONT TX
77705-9440
US

V. Phone/Fax

Practice location:
  • Phone: 409-504-4596
  • Fax:
Mailing address:
  • Phone: 409-504-4596
  • Fax: 409-220-6456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: SEAN A MARTIN
Title or Position: OWNER
Credential: LPC
Phone: 409-504-4596