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General NPI Number Information
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NPI Number | 1093938144
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CONCEPTS
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1501 E RED RIVER ST SUITE A-1
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City | VICTORIA
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State | TX
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Zip | 77901-5522
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Country | US
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Telephone | 361-578-2800
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Fax | 361-578-2804
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Provider Business Mailing Address
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Address Line | 1501 E RED RIVER ST. SUITE A-1
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City | VICTORIA
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State | TX
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Zip | 77901-5522
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Country | US
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Telephone | 361-578-2800
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Fax | 361-578-2804
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHNNIE C. LA QUAY II
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Credential | L.P.C.
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Telephone | 361-578-2800
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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 | 18848
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License Number State | TX
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