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General NPI Number Information
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NPI Number | 1952614158
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Entity Type | Organization
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Legal Business Name | WHOLE LIFE COUNSELING AND RESOURCE CENTER OF TEXAS
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 8590 CRESTWAY DR
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City | CONVERSE
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State | TX
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Zip | 78109-3425
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Country | US
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Telephone | 210-661-3030
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Fax | 210-310-0818
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Provider Business Mailing Address
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Address Line | 8590 CRESTWAY DR
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City | CONVERSE
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State | TX
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Zip | 78109-3425
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Country | US
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Telephone | 210-661-3030
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Fax | 210-310-0818
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | MRS. EMMA JANE FRAZIER
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Credential | LPC
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Telephone | 210-857-7860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 19115
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License Number State | TX
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