=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154809275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEXAS BEHAVIORAL COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2018
-----------------------------------------------------
Last Update Date | 07/31/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 S COOPER ST STE 9
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76001-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-988-9635
-----------------------------------------------------
Fax | 817-549-9993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 S COOPER ST STE 9
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76001-6718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-988-9635
-----------------------------------------------------
Fax | 817-549-9993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHRYN JOHNSON
-----------------------------------------------------
Credential | LPC-S, NCC
-----------------------------------------------------
Telephone | 817-988-9635
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------