Healthcare Provider Details

I. General information

NPI: 1073770921
Provider Name (Legal Business Name): COUNSELING RESOURCE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HOUSTON ST
TOMBALL TX
77375-4759
US

IV. Provider business mailing address

111 HOUSTON ST
TOMBALL TX
77375-4759
US

V. Phone/Fax

Practice location:
  • Phone: 281-255-9922
  • Fax: 281-255-9064
Mailing address:
  • Phone: 281-255-9922
  • Fax: 281-255-9064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number61425
License Number StateTX

VIII. Authorized Official

Name: MRS. ANN MARIE BOLTON
Title or Position: PRESIDENT
Credential: LPC
Phone: 281-255-9922