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General NPI Number Information
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NPI Number | 1700240272
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Entity Type | Individual
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Provider Name | ADALID SIS LPC
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Gender | Female
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 3320 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-6984
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Country | US
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Telephone | 903-723-6136
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Fax | 903-586-4234
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Provider Business Mailing Address
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Address Line | 1011 COLLEGE AVE
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City | JACKSONVILLE
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State | TX
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Zip | 75766-3307
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Country | US
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Telephone | 903-586-5507
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Fax | 903-586-4234
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 69638
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 69638
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License Number State | TX
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