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General NPI Number Information
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NPI Number | 1891187910
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Entity Type | Organization
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Legal Business Name | FOURTH DIMENSION COUNSELING SERVICES
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Dates
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Enumeration Date | 02/26/2015
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Last Update Date | 02/26/2015
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Provider Practice Location Address
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Address Line | 2616 S LOOP W SUITE 655
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 832-581-2970
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 S LOOP W SUITE 655
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 832-581-2970
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CARL MICHAEL POOLE
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Credential | LCDC
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Telephone | 832-581-2970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 3830-3831
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 3830-3831
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 3830-3831
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3830-3831
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License Number State | TX
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