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General NPI Number Information
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NPI Number | 1336655810
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Entity Type | Organization
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Legal Business Name | EASY OPTIMISTIC LIVING COUNSELING
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Dates
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Enumeration Date | 12/20/2017
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Last Update Date | 12/20/2017
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Provider Practice Location Address
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Address Line | 1428 E 8TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4803
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Country | US
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Telephone | 432-934-5974
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Fax | 432-552-8412
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Provider Business Mailing Address
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Address Line | 1428 E 8TH ST
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City | ODESSA
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State | TX
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Zip | 79761-4803
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Country | US
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Telephone | 432-934-5974
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Fax | 432-552-8412
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Authorized Official
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Title or Position | PRESIDENT
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Name | ESTELLA V MOLINA
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Credential | LPC
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Telephone | 432-934-5974
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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 | 70620
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License Number State | TX
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