Healthcare Provider Details

I. General information

NPI: 1639633696
Provider Name (Legal Business Name): IN HIS IMAGE COUNSELING CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 W. AIRPORT FWY SUITE 244
IRVING TX
75062
US

IV. Provider business mailing address

4425 W. AIRPORT FWY SUITE 244
IRVING TX
75062
US

V. Phone/Fax

Practice location:
  • Phone: 214-441-3797
  • Fax: 888-975-2092
Mailing address:
  • Phone: 214-441-3797
  • Fax: 888-975-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SUZANNE MARY BAARS
Title or Position: OWNER
Credential: PHD
Phone: 214-441-3797