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General NPI Number Information
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NPI Number | 1811186091
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL EDUCATION & GROWTH SERVICES
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 301 S CENTER ST SUITE 214
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City | ARLINGTON
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State | TX
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Zip | 76010-7139
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Country | US
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Telephone | 817-276-6412
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Fax | 817-276-6438
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Provider Business Mailing Address
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Address Line | 301 S CENTER ST SUITE 214
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City | ARLINGTON
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State | TX
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Zip | 76010-7139
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Country | US
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Telephone | 817-276-6412
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Fax | 817-276-6438
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | MR. WILLIAM JOHN NICHOLS
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Credential | LPC
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Telephone | 817-276-6412
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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 | 12623
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License Number State | TX
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