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General NPI Number Information
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NPI Number | 1396936456
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Entity Type | Organization
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Legal Business Name | LIFE STAGES COUNSELING
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 2407 HAINE DR
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City | HARLINGEN
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State | TX
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Zip | 78550-8592
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Country | US
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Telephone | 956-200-7884
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Fax | 956-412-2404
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Provider Business Mailing Address
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Address Line | PO BOX 1462
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City | HARLINGEN
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State | TX
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Zip | 78551-1462
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Country | US
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Telephone | 956-200-7884
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Fax | 956-412-2404
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD D COOLEY
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Credential | LPC
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Telephone | 956-200-7884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 60413
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License Number State | TX
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