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General NPI Number Information
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NPI Number | 1588284848
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Entity Type | Organization
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Legal Business Name | PRIME COUNSELING
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Dates
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Enumeration Date | 04/16/2020
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Last Update Date | 04/16/2020
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Provider Practice Location Address
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Address Line | 13140 COIT RD STE 215
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City | DALLAS
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State | TX
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Zip | 75240-5786
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Country | US
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Telephone | 817-677-8353
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Fax |
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Provider Business Mailing Address
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Address Line | 6472 TRAMMEL DR
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City | DALLAS
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State | TX
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Zip | 75214-2219
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Country | US
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Telephone | 713-557-8430
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER SHOTWELL
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Credential | MA, MBA, LPC, LCDC,
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Telephone | 713-557-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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