=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518348879
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PMG COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/12/2015
-----------------------------------------------------
Last Update Date | 06/12/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 204 SHAWNEE ST
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76832-2145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-228-4152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 204 SHAWNEE
-----------------------------------------------------
City | CHEROKEE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-228-4152
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR
-----------------------------------------------------
Name | PAMELA M GARCIA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 361-228-4152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 71129
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------