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General NPI Number Information
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NPI Number | 1194277004
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Entity Type | Organization
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Legal Business Name | INNOVATE COUNSELING & WELLNESS, PLLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 801 E PLANO PKWY STE. 150
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City | PLANO
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State | TX
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Zip | 75074-6746
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Country | US
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Telephone | 214-952-2455
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Fax | 972-867-6312
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Provider Business Mailing Address
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Address Line | 801 E PLANO PKWY STE. 150
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City | PLANO
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State | TX
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Zip | 75074-6746
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Country | US
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Telephone | 214-952-2455
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Fax | 972-867-6312
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Authorized Official
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Title or Position | MANAGER
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Name | TAMARA LJUBISIC
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Credential | LPC, CST
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Telephone | 214-952-2455
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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 | 70338
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License Number State | TX
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