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General NPI Number Information
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NPI Number | 1417314089
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Entity Type | Organization
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Legal Business Name | FUNDAMENTAL FOUNDATIONS COUNSELING CENTER, PLLC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 2770 MAIN ST STE. 280
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City | FRISCO
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State | TX
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Zip | 75033-4302
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Country | US
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Telephone | 214-475-0345
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Fax | 214-935-3302
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Provider Business Mailing Address
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Address Line | 2770 MAIN ST STE. 280
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City | FRISCO
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State | TX
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Zip | 75033-4302
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Country | US
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Telephone | 214-475-0345
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Fax | 214-935-3302
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Authorized Official
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Title or Position | CEO/ CLINICAL DIRECTOR
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Name | SHAHIDRAH COWGILL
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Credential | LPC-S, NCC
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Telephone | 214-475-0345
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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 | 64254
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License Number State | TX
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