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General NPI Number Information
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NPI Number | 1285807958
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Entity Type | Organization
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Legal Business Name | EAST TEXAS CENTER FOR INDEPENDENT LIVING
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Dates
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Enumeration Date | 04/02/2008
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 719 W FRONT ST STE 100
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City | TYLER
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State | TX
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Zip | 75702-7961
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Country | US
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Telephone | 903-581-7542
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Fax | 903-581-8289
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Provider Business Mailing Address
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Address Line | 719 W FRONT ST STE 100
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City | TYLER
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State | TX
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Zip | 75702-7961
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Country | US
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Telephone | 903-581-7542
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Fax | 903-581-8289
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JOANNA RICHARDSON
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Credential | LPC, ASDCS
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Telephone | 903-581-7542
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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 |
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License Number State |
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