Healthcare Provider Details

I. General information

NPI: 1154031193
Provider Name (Legal Business Name): NEW PATH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E HIGHWAY 199 STE 102
SPRINGTOWN TX
76082-2758
US

IV. Provider business mailing address

505 SUMMER TREE CT
SPRINGTOWN TX
76082-2267
US

V. Phone/Fax

Practice location:
  • Phone: 682-587-7353
  • Fax:
Mailing address:
  • Phone: 817-946-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMBER LEIGH GENTRY LOPEZ
Title or Position: OWNER
Credential: MED, LPC-S, RPT-S
Phone: 817-946-9863