=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912311267
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNSELING, CONSULTING, & INSPIRATION ASSOCIATES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2014
-----------------------------------------------------
Last Update Date | 10/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3500 OAK LAWN AVE STE 620
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-499-8181
-----------------------------------------------------
Fax | 214-559-2797
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3500 OAK LAWN AVE STE 620
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75219-4462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-499-8181
-----------------------------------------------------
Fax | 214-559-2797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. GARY G KINDLEY
-----------------------------------------------------
Credential | D.MIN., LPC
-----------------------------------------------------
Telephone | 214-499-8181
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 70643
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------