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General NPI Number Information
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NPI Number | 1710590575
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Entity Type | Organization
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Legal Business Name | SOLID TRAILS COUNSELING AND CONSULTING PLLC
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 14090 SOUTHWEST FWY STE 300
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City | SUGAR LAND
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State | TX
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Zip | 77478-3679
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Country | US
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Telephone | 346-375-7281
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Fax |
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Provider Business Mailing Address
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Address Line | 14090 SOUTHWEST FWY STE 300
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City | SUGAR LAND
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State | TX
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Zip | 77478-3679
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Country | US
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Telephone | 832-775-6416
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Fax |
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Authorized Official
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Title or Position | CEO/ LEAD CLINICIAN
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Name | MR. CEDRIC ITA EYO
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Credential | LPC
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Telephone | 346-375-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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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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