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General NPI Number Information
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NPI Number | 1073834594
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Entity Type | Organization
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Legal Business Name | COUNSELING PROFESSIONALS OF NORTHEAST TEXAS
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 737 LAMAR AVE
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City | PARIS
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State | TX
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Zip | 75460-4479
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Country | US
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Telephone | 903-785-0400
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Fax | 903-785-0403
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Provider Business Mailing Address
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Address Line | 737 LAMAR AVENUE
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City | PARIS
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State | TX
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Zip | 75460-4479
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Country | US
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Telephone | 903-785-0400
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Fax | 903-785-0403
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Authorized Official
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Title or Position | LPC
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Name | MRS. RONIKAYE JOPLIN RUSAK
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Credential | MS
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Telephone | 903-785-0400
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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 | 63582
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License Number State | TX
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