Healthcare Provider Details

I. General information

NPI: 1497493076
Provider Name (Legal Business Name): M.P. COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 JACK CT
LONGVIEW TX
75601-8716
US

IV. Provider business mailing address

806 JACK CT
LONGVIEW TX
75601-8716
US

V. Phone/Fax

Practice location:
  • Phone: 903-309-0702
  • Fax:
Mailing address:
  • Phone: 903-309-0702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARY CARMEN PEREZ
Title or Position: OWNER
Credential: LCSW
Phone: 903-309-0702