Healthcare Provider Details

I. General information

NPI: 1720484959
Provider Name (Legal Business Name): AMERICAN COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 DYER ST SUITE 419
EL PASO TX
79904-2867
US

IV. Provider business mailing address

8888 DYER ST SUITE 419
EL PASO TX
79904-2867
US

V. Phone/Fax

Practice location:
  • Phone: 915-886-8793
  • Fax:
Mailing address:
  • Phone: 915-886-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number68877
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number68877
License Number StateTX

VIII. Authorized Official

Name: MICHAEL KEITH WADE
Title or Position: OWNER
Credential: LPC
Phone: 915-886-8793