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General NPI Number Information
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NPI Number | 1154722908
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Entity Type | Organization
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Legal Business Name | 164 COUNSELING SERVICES
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Dates
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Enumeration Date | 09/11/2014
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Last Update Date | 09/11/2014
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Provider Practice Location Address
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Address Line | 701 NE 5TH ST SUITE A
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City | HUBBARD
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State | TX
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Zip | 76648-2203
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Country | US
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Telephone | 254-576-1040
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Fax |
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Provider Business Mailing Address
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Address Line | 5526 DYER ST
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City | DALLAS
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State | TX
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Zip | 75206-5031
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Country | US
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Telephone | 214-934-8844
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Fax |
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Authorized Official
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Title or Position | OWNER, CEO
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Name | MR. WILLIAM W PORTER
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Credential |
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Telephone | 214-934-8844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3775-3776
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License Number State | TX
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