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General NPI Number Information
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NPI Number | 1073736864
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Entity Type | Organization
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Legal Business Name | HILLSIDE COUNSELING LLC
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 112 SW THOMAS ST SUITE 104
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City | BURLESON
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State | TX
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Zip | 76028-3818
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Country | US
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Telephone | 817-694-0722
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Fax |
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Provider Business Mailing Address
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Address Line | 106 FAIRWAY DR
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City | WILLOW PARK
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State | TX
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Zip | 76087-8886
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Country | US
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Telephone | 817-694-0722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PENNE SCHULZ
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Credential | MS, LPC
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Telephone | 817-694-0722
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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 | 65286
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License Number State | TX
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