=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962565853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE COUNSELING INSTITUTE OF TEXAS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 09/24/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 705 W AVENUE B SUITE 200
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75040-6230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-494-0160
-----------------------------------------------------
Fax | 972-494-0431
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3200 SOUTHERN DR SUITE 100
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75043-1549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-271-4300
-----------------------------------------------------
Fax | 972-271-4302
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. MARIA T. MOLETT
-----------------------------------------------------
Credential | LPC, LSOTP
-----------------------------------------------------
Telephone | 972-271-4300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------