Healthcare Provider Details

I. General information

NPI: 1164075834
Provider Name (Legal Business Name): VALLEY TO SUMMIT COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2019
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 US HIGHWAY 287
RHOME TX
76078-4323
US

IV. Provider business mailing address

134 PR 3576
BOYD TX
76023
US

V. Phone/Fax

Practice location:
  • Phone: 817-894-1170
  • Fax:
Mailing address:
  • Phone: 817-894-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP HAYS
Title or Position: COUNSELOR
Credential: LPC
Phone: 817-894-1170