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General NPI Number Information
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NPI Number | 1194279042
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Entity Type | Organization
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Legal Business Name | MINEOLA COUNSELING SERVICES
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 08/09/2016
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Provider Practice Location Address
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Address Line | 620 E BROAD ST SUITE #9
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City | MINEOLA
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State | TX
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Zip | 75773-2622
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Country | US
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Telephone | 972-832-8047
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Fax |
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Provider Business Mailing Address
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Address Line | 620 E BROAD ST SUITE #9
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City | MINEOLA
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State | TX
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Zip | 75773-2622
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Country | US
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Telephone | 972-832-8047
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | MS. AVA N. WEAVER
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Credential | M.S.,NCC,LPCS
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Telephone | 972-832-8047
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19952
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License Number State | TX
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