Healthcare Provider Details

I. General information

NPI: 1720229743
Provider Name (Legal Business Name): LCDCCOUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 MONTREAL LN
GLENN HEIGHTS TX
75154-8224
US

IV. Provider business mailing address

1530 MONTREAL LN
GLENN HEIGHTS TX
75154-8224
US

V. Phone/Fax

Practice location:
  • Phone: 469-226-9982
  • Fax:
Mailing address:
  • Phone: 469-226-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number10826
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number10826
License Number StateTX

VIII. Authorized Official

Name: MR. RODNEY W TAYLOR
Title or Position: PROGRAM DIRECTOR/SENIOR COUNSELOR
Credential: MA;LCDC;ADS;LPC-I
Phone: 469-226-9982