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General NPI Number Information
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NPI Number | 1679825509
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Entity Type | Organization
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Legal Business Name | PRACTICAL COUNSELING SERVICES
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 3212 COLLINSWORTH ST STE 22 SUITE 22
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City | FORT WORTH
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State | TX
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Zip | 76107-6507
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Country | US
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Telephone | 817-829-4749
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16071
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City | FORT WORTH
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State | TX
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Zip | 76162-0071
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Country | US
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Telephone | 817-829-4749
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Fax |
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Authorized Official
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Title or Position | CEO/THERAPIST
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Name | MRS. LESHAUNNE CHARISE COXUM
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Credential | LPC
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Telephone | 817-829-4749
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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 | 63906
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License Number State | TX
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