Healthcare Provider Details

I. General information

NPI: 1699076026
Provider Name (Legal Business Name): PROFESSIONAL COUNSELING SERVICES OF NETX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S. MAIN STREET
LEONARD TX
75452-3113
US

IV. Provider business mailing address

PO BOX 48
LEONARD TX
75452-0048
US

V. Phone/Fax

Practice location:
  • Phone: 903-268-3878
  • Fax: 903-587-3101
Mailing address:
  • Phone: 903-268-3878
  • Fax: 903-587-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14952
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number17360
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14952
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17360
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14952
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17360
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14952
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17360
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number14952
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number17360
License Number StateTX

VIII. Authorized Official

Name: MR. DAVID JAMES BUTLER
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 903-268-3878