=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144069964
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAT L PASTORS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3131 EXECUTIVE DR
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76904-6801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-234-5164
-----------------------------------------------------
Fax | 325-610-6122
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3201 SIERRA DR
-----------------------------------------------------
City | SAN ANGELO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76904-6935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-234-5164
-----------------------------------------------------
Fax | 325-610-6122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PATRICIA L. PASTORS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 325-234-5164
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------