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General NPI Number Information
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NPI Number | 1356040935
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Entity Type | Organization
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Legal Business Name | ENDEAVOR COUNSELING CENTER LLC
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 4635 NE STALLINGS DR STE 104
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1667
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Country | US
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Telephone | 936-209-4090
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Fax |
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Provider Business Mailing Address
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Address Line | 4635 NE STALLINGS DR STE 104
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City | NACOGDOCHES
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State | TX
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Zip | 75965-1667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE MIXON
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Credential |
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Telephone | 936-209-4090
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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 |
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License Number State |
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