Healthcare Provider Details

I. General information

NPI: 1740677673
Provider Name (Legal Business Name): GOLDEN POND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 04/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

567 JOSSERAND RD
GROVETON TX
75845-4793
US

IV. Provider business mailing address

567 JOSSERAND RD PO BOX 1264
GROVETON TX
75845-4793
US

V. Phone/Fax

Practice location:
  • Phone: 936-676-7656
  • Fax: 936-642-2095
Mailing address:
  • Phone: 936-676-7656
  • Fax: 936-642-2129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number70161
License Number StateTX

VIII. Authorized Official

Name: MRS. MARY A CURTIS
Title or Position: LICENSE PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 936-676-7656