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General NPI Number Information
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NPI Number | 1063651412
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Entity Type | Organization
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Legal Business Name | KOINONIA CHRISTIAN COUNSELING, P.A.
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Dates
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Enumeration Date | 02/09/2009
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Last Update Date | 02/09/2009
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Provider Practice Location Address
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Address Line | 6021 MORRISS RD SUITE 109A
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City | FLOWER MOUND
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State | TX
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Zip | 75028-3710
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Country | US
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Telephone | 940-783-8135
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 BALLYCASTLE LN
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City | CORINTH
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State | TX
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Zip | 76210-0084
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Country | US
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Telephone | 940-783-8135
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Fax | 940-539-3185
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDA MASON
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Credential | LMFT
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Telephone | 940-783-8135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 201140
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License Number State | TX
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