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General NPI Number Information
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NPI Number | 1417281643
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Entity Type | Organization
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Legal Business Name | COUNTRY BREEZE COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 09/21/2009
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Last Update Date | 09/21/2009
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Provider Practice Location Address
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Address Line | 16486 FM 463
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City | LYTLE
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State | TX
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Zip | 78052-4514
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Country | US
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Telephone | 830-709-0711
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Fax | 830-772-3808
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Provider Business Mailing Address
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Address Line | 17875 FM 463
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City | NATALIA
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State | TX
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Zip | 78059-2338
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Country | US
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Telephone | 830-709-0711
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Fax | 830-772-3808
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Authorized Official
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Title or Position | OWNER-COUNSELOR
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Name | MS. DONNA BECK GRANATO
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Credential | M.S., LPC.
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Telephone | 830-709-0711
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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 | 63654
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 14243
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License Number State | TX
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