=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750324414
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2006
-----------------------------------------------------
Last Update Date | 05/10/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 W 8TH AVE SUITE 800
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79101-2399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-353-1668
-----------------------------------------------------
Fax | 806-353-1668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 W 8TH AVE SUITE 800
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79101-2399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-353-1668
-----------------------------------------------------
Fax | 806-353-1668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. TWILLA WOOLSEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 806-353-1668
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------