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General NPI Number Information
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NPI Number | 1821442823
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Entity Type | Organization
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Legal Business Name | ESSENTIAL HEALING COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 04/16/2016
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Last Update Date | 04/16/2016
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Provider Practice Location Address
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Address Line | 12335 HYMEADOW DR SUITE 300
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City | AUSTIN
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State | TX
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Zip | 78750-1934
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Country | US
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Telephone | 512-968-4902
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | GRANGER
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State | TX
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Zip | 76530-0494
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Country | US
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Telephone | 512-887-4325
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BAILEY BEARD
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Credential | LPC
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Telephone | 512-968-4902
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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 | 71614
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License Number State | TX
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