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General NPI Number Information
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NPI Number | 1740410059
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Entity Type | Organization
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Legal Business Name | SJCARDWELL COUNSELING & CONSULTING, PLLC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 2304 MIDWESTERN PKWY SUITE 103A
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2342
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Country | US
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Telephone | 940-691-1267
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Fax | 940-691-1582
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Provider Business Mailing Address
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Address Line | 2304 MIDWESTERN PKWY SUITE 103A
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City | WICHITA FALLS
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State | TX
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Zip | 76308-2342
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Country | US
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Telephone | 940-691-1267
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Fax | 940-691-1582
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Authorized Official
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Title or Position | OWNER
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Name | MS. SUSAN J CARDWELL
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Credential | LPC,MA
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Telephone | 940-691-1267
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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 | 19099
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License Number State | TX
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