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General NPI Number Information
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NPI Number | 1881944627
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Entity Type | Organization
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Legal Business Name | NORTHWEST LIFE SKILLS COUNSELING
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 2636 WALNUT HILL LN SUITE # 330
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City | DALLAS
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State | TX
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Zip | 75229-5639
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Country | US
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Telephone | 214-358-6826
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Fax | 214-358-6873
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Provider Business Mailing Address
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Address Line | 2636 WALNUT HILL LANE SUITE # 330
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City | DALLAS
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State | TX
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Zip | 75229
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Country | US
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Telephone | 214-358-6826
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Fax | 214-358-6873
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Authorized Official
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Title or Position | C.E.O.
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Name | GINA F. VELEZ
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Credential | LCDC,CPS,IDAC
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Telephone | 214-358-6826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6571
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License Number State | TX
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