Healthcare Provider Details

I. General information

NPI: 1063867265
Provider Name (Legal Business Name): RGV COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 N 10TH ST SUITE 124
MCALLEN TX
78504-2751
US

IV. Provider business mailing address

1216 W FERN AVE
MCALLEN TX
78501-3933
US

V. Phone/Fax

Practice location:
  • Phone: 956-369-7997
  • Fax: 805-283-8480
Mailing address:
  • Phone: 956-369-7997
  • Fax: 805-283-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number67293
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67293
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67293
License Number StateTX

VIII. Authorized Official

Name: JEANETTE GONZALEZ BALLESTEROS
Title or Position: DIRECTOR
Credential:
Phone: 956-369-7997