=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063059871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE COUNSELING CENTER OF TEXAS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2019
-----------------------------------------------------
Last Update Date | 11/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13601 PRESTON RD STE 702W
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-646-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13601 PRESTON RD STE 702W
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-5359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-646-6350
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOSEPH BRIGANDI
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 469-646-6350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------