Healthcare Provider Details

I. General information

NPI: 1396874103
Provider Name (Legal Business Name): HENNEBURG COUNSELING CENTER, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6090 SURETY DRIVE SUITE 105
EL PASO TX
79905-2060
US

IV. Provider business mailing address

6090 SURETY DRIVE SUITE 105
EL PASO TX
79905-2060
US

V. Phone/Fax

Practice location:
  • Phone: 915-778-3807
  • Fax: 915-779-6600
Mailing address:
  • Phone: 915-778-3807
  • Fax: 915-779-6600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13071
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number2088-A
License Number StateTX

VIII. Authorized Official

Name: MS. ESTEFANIA VENEGAS
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 915-778-3807