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General NPI Number Information
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NPI Number | 1134330392
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Entity Type | Organization
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Legal Business Name | COUNSELING AND PSYCHOLOGICAL SERVICES OF EAST TEXAS, PC
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Dates
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Enumeration Date | 05/26/2007
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Last Update Date | 10/30/2013
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Provider Practice Location Address
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Address Line | 301 N WELLINGTON ST
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City | MARSHALL
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State | TX
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Zip | 75670-3335
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Country | US
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Telephone | 903-938-4476
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Fax | 903-938-4125
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Provider Business Mailing Address
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Address Line | PO BOX 8317
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City | MARSHALL
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State | TX
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Zip | 75671-8317
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Country | US
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Telephone | 903-938-4476
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Fax | 903-938-4125
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONEY L CHARLES JR.
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Credential | PH.D.
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Telephone | 903-938-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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