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General NPI Number Information
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NPI Number | 1790031060
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Entity Type | Organization
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Legal Business Name | FAMILY TREE COUNSELING, PLLC
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Dates
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Enumeration Date | 07/24/2012
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Last Update Date | 07/24/2012
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Provider Practice Location Address
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Address Line | 5309 VILLAGE CREEK DR #100
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City | PLANO
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State | TX
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Zip | 75093-4841
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Country | US
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Telephone | 469-443-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 18619 REMBRANDT TER
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City | DALLAS
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State | TX
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Zip | 75287-3409
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Country | US
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Telephone | 469-363-6264
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA MARTILIK
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Credential |
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Telephone | 469-363-6264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 61514
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License Number State | TX
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