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General NPI Number Information
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NPI Number | 1083441216
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Entity Type | Organization
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Legal Business Name | PEBBLE PATH COUNSELING LLC
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Dates
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Enumeration Date | 09/19/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 5600 W LOVERS LANE SUITE 116 # 158
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City | DALLAS
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State | TX
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Zip | 75209
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Country | US
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Telephone | 805-234-4493
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Fax |
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Provider Business Mailing Address
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Address Line | 3130 N HARWOOD ST APT 2606
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City | DALLAS
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State | TX
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Zip | 75201-1140
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Country | US
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Telephone | 805-234-4493
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | ROBIN STEVENS
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Credential | LCSW
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Telephone | 805-234-4493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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