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General NPI Number Information
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NPI Number | 1831884352
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Entity Type | Organization
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Legal Business Name | MEADOW BRIDGE COUNSELING LLC
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Dates
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Enumeration Date | 04/10/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 4102 RICHMOND MDWS STE A
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City | TEXARKANA
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State | TX
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Zip | 75503-0067
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Country | US
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Telephone | 903-278-7418
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6671
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City | TEXARKANA
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State | TX
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Zip | 75505-6671
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Country | US
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Telephone | 903-278-7418
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Fax |
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Authorized Official
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Title or Position | LLC MEMBER
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Name | SHAUNA LOE
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Credential | LPC
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Telephone | 903-278-7418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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