=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669077236
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRANE'S COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/02/2020
-----------------------------------------------------
Last Update Date | 12/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2600 S LOOP W STE 475B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-720-2149
-----------------------------------------------------
Fax | 877-883-8370
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2600 S LOOP W STE 475B
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77054-2681
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-720-2149
-----------------------------------------------------
Fax | 877-883-8370
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. DOMONICK FITZGERALD CRANE SR.
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 832-720-2149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------