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General NPI Number Information
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NPI Number | 1780490532
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Entity Type | Individual
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Provider Name | SYDNEY ESHBAUGH
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Gender | Female
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 111 UNIVERSITY DR E STE 206
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City | COLLEGE STATION
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State | TX
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Zip | 77840-1700
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Country | US
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Telephone | 936-521-9073
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Fax |
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Provider Business Mailing Address
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Address Line | 702 W RIECK RD
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City | TYLER
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State | TX
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Zip | 75703-3526
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 93314
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License Number State | TX
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