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General NPI Number Information
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NPI Number | 1124639489
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Entity Type | Organization
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Legal Business Name | KINGWOOD COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 1521 GREEN OAK PL STE 250
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City | KINGWOOD
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State | TX
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Zip | 77339-2044
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Country | US
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Telephone | 281-608-1346
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Fax | 832-436-1648
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Provider Business Mailing Address
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Address Line | 1521 GREEN OAK PL STE 250
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City | KINGWOOD
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State | TX
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Zip | 77339-2044
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Country | US
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Telephone | 281-608-1346
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Fax | 832-436-1648
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DONNA MARIE BULLARD
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Credential |
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Telephone | 323-347-8128
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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 |
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License Number State |
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Taxonomy #2
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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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