=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942455613
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C-KUBED COUNSELING, COACHING AND CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2008
-----------------------------------------------------
Last Update Date | 03/26/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 W PLEASANT RUN RD SUITE 300
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75146-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-601-0193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2700 W PLEASANT RUN RD SUITE 300
-----------------------------------------------------
City | LANCASTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75146-1079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-601-0193
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SHAWN DELORES WHITE-MUHAMMED
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 214-601-0193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 50248
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------