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General NPI Number Information
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NPI Number | 1700496270
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Entity Type | Organization
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Legal Business Name | AVANTI COUNSELING & CONSULTING
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Dates
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Enumeration Date | 08/08/2020
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 1560 E SOUTHLAKE BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6462
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Country | US
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Telephone | 682-593-5693
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Fax |
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Provider Business Mailing Address
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Address Line | 4056 SUMMERHILL LN
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City | FORT WORTH
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State | TX
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Zip | 76244-4905
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Country | US
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Telephone | 832-794-3209
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | JEREMY L PIERCE
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Credential | MA, LPC-S, LMFT-S
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Telephone | 682-593-5693
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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