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General NPI Number Information
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NPI Number | 1417508169
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Entity Type | Organization
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Legal Business Name | CANVAS COUNSELING AND WELLNESS PLLC
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 1401 N CENTRAL EXPY STE 120
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City | RICHARDSON
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State | TX
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Zip | 75080-4669
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Country | US
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Telephone | 214-307-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 120 E GRUBB DR UNIT 852751
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City | MESQUITE
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State | TX
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Zip | 75185-5130
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Country | US
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Telephone | 214-307-2340
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Fax |
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Authorized Official
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Title or Position | OWNER & LICENSED PROFESSIONAL COUNS
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Name | REBECCA DANIELLE HOGG
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Credential | MA, LPC, RPT
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Telephone | 214-307-2340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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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 |
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License Number State |
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