Healthcare Provider Details

I. General information

NPI: 1780590612
Provider Name (Legal Business Name): CRAIG BLACK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 ROSEBAY DR
JUSTIN TX
76247-1246
US

IV. Provider business mailing address

1229 ROSEBAY DR
JUSTIN TX
76247-1246
US

V. Phone/Fax

Practice location:
  • Phone: 214-699-9016
  • Fax:
Mailing address:
  • Phone: 214-699-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CRAIG BLACK
Title or Position: OWNER
Credential:
Phone: 214-699-9016