Healthcare Provider Details

I. General information

NPI: 1205604725
Provider Name (Legal Business Name): JIREH COUNSELING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/14/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 25TH AVE N STE 103
TEXAS CITY TX
77590-5280
US

IV. Provider business mailing address

2000 25TH AVE N STE 103
TEXAS CITY TX
77590-5280
US

V. Phone/Fax

Practice location:
  • Phone: 346-874-7105
  • Fax: 409-440-8520
Mailing address:
  • Phone: 346-874-7105
  • Fax: 409-440-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. VERDALE GOINS
Title or Position: OWNER/THERAPIST
Credential: PHD, LPC
Phone: 720-351-8424