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General NPI Number Information
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NPI Number | 1710489117
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Entity Type | Organization
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Legal Business Name | STAGE OF LIFE COUNSELING LLC
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Dates
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Enumeration Date | 03/02/2018
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Last Update Date | 03/02/2018
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Provider Practice Location Address
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Address Line | 2525 WALLINGWOOD DR
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City | AUSTIN
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State | TX
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Zip | 78746-6900
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Country | US
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Telephone | 512-350-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 WALLINGWOOD DR
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City | AUSTIN
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State | TX
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Zip | 78746-6900
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Country | US
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Telephone | 512-350-8505
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JINJI D WILLINGHAM
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Credential | MA, C. PHIL, LPC
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Telephone | 512-350-8505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health 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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73509
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License Number State | TX
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