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General NPI Number Information
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NPI Number | 1093348443
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Entity Type | Organization
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Legal Business Name | SOUTHEAST TEXAS COUNSELING & ASSESSMENT SERVICES, PLLC
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 06/29/2020
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Provider Practice Location Address
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Address Line | 2626 CALDER ST STE 204
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City | BEAUMONT
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State | TX
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Zip | 77702-1926
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Country | US
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Telephone | 409-504-4596
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Fax |
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Provider Business Mailing Address
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Address Line | 11126 GAULDING RD
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City | BEAUMONT
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State | TX
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Zip | 77705-9440
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Country | US
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Telephone | 409-504-4596
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Fax | 409-220-6456
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Authorized Official
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Title or Position | OWNER
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Name | SEAN A MARTIN
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Credential | LPC
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Telephone | 409-504-4596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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