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General NPI Number Information
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NPI Number | 1639884091
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Entity Type | Organization
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Legal Business Name | UNLATCHED MIND COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 01/19/2023
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Last Update Date | 01/19/2023
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Provider Practice Location Address
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Address Line | 2501 4TH AVE
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City | CANYON
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State | TX
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Zip | 79016-0001
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Country | US
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Telephone | 936-262-1677
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 RESEARCH FOREST DR STE 400
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City | SPRING
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State | TX
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Zip | 77382-1482
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Country | US
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Telephone | 936-262-1677
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Fax | 888-573-6551
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Authorized Official
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Title or Position | OWNER/COUNSELOR
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Name | GABRIELLE GALVAN
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Credential | LPC
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Telephone | 936-262-1677
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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 |
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License Number State |
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