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General NPI Number Information
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NPI Number | 1043529407
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Entity Type | Organization
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Legal Business Name | PROVIDENTIAL COUNSELING AND CONSULTING SERVICES, PLLC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 10/04/2010
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Provider Practice Location Address
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Address Line | 2656 S LOOP W STE 305
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City | HOUSTON
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State | TX
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Zip | 77054-2674
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Country | US
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Telephone | 832-767-0760
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Fax | 832-767-0763
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Provider Business Mailing Address
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Address Line | 11313 WINDY DAWN DR
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City | PEARLAND
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State | TX
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Zip | 77584-8216
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Country | US
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Telephone | 713-436-3532
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Fax |
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Authorized Official
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Title or Position | LPC/OWNER
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Name | RICHELLE WHITTAKER
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Credential |
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Telephone | 832-767-0760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 64015
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License Number State | TX
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