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General NPI Number Information
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NPI Number | 1336785294
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Entity Type | Organization
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Legal Business Name | ESSENTIAL COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 3915 OUTLOOK BLVD STE B2
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City | PUEBLO
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State | CO
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Zip | 81008-2604
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Country | US
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Telephone | 719-569-5653
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Fax |
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Provider Business Mailing Address
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Address Line | 1058 S AVENIDA DEL ORO E
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City | PUEBLO WEST
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State | CO
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Zip | 81007-2072
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Country | US
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Telephone | 719-569-5653
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JADE MONIQUE MIXON
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Credential | LCSW
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Telephone | 719-569-5653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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