=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306222435
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNCOMMON WISDOM COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2015
-----------------------------------------------------
Last Update Date | 07/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 BELT LINE RD SUITE 215
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75040-3299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-901-5010
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 BELT LINE RD SUITE 215
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75040-3299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | BLANCA SCRIBNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 972-400-7795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 66569
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------