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General NPI Number Information
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NPI Number | 1326396888
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Entity Type | Organization
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Legal Business Name | COVENANT COUNSELING
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 08/15/2012
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Provider Practice Location Address
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Address Line | 5214 THOMASON DR
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City | MIDLAND
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State | TX
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Zip | 79703-6000
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Country | US
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Telephone | 432-528-0290
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Fax |
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Provider Business Mailing Address
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Address Line | 5214 THOMASON DR
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City | MIDLAND
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State | TX
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Zip | 79703-6000
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Country | US
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Telephone | 432-528-0290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARC MCQUEEN
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Credential |
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Telephone | 432-528-0290
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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 | 14525
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License Number State | TX
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