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General NPI Number Information
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NPI Number | 1093467227
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Entity Type | Organization
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Legal Business Name | COURAGEOUS COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 6510 POLARIS DR STE 2
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City | LAREDO
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State | TX
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Zip | 78041-2054
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Country | US
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Telephone | 956-707-3076
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 CUATRO VIENTOS DR
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City | LAREDO
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State | TX
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Zip | 78046-6978
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Country | US
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Telephone | 959-707-3076
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Fax |
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Authorized Official
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Title or Position | OWNER / PROVIDER
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Name | MR. JONATHAN SERNA
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Credential | LPC
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Telephone | 956-413-1150
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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 |
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License Number State |
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