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General NPI Number Information
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NPI Number | 1730619537
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Entity Type | Organization
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Legal Business Name | INTREPID COUNSELING
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 06/14/2017
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Provider Practice Location Address
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Address Line | 3900 W 15TH ST STE 305
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City | PLANO
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State | TX
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Zip | 75075-4725
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Country | US
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Telephone | 917-541-9112
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Fax |
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Provider Business Mailing Address
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Address Line | 4213 DICKASON AVE APT 1
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City | DALLAS
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State | TX
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Zip | 75219-3533
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Country | US
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Telephone | 917-541-9112
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | DOV RABINOWITZ
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Credential | LCSW, LCDC
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Telephone | 917-541-9112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 12148
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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 | 54998
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License Number State | TX
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