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General NPI Number Information
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NPI Number | 1982152948
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Entity Type | Organization
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Legal Business Name | THE LISTENING RETREAT
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 305 REGENCY PKWY 413
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City | MANSFIELD
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State | TX
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Zip | 76063-3794
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Country | US
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Telephone | 682-292-8255
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Fax | 682-201-2225
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Provider Business Mailing Address
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Address Line | 1709 SCOTTSDALE DR
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City | ARLINGTON
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State | TX
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Zip | 76018-1868
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/LPC
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Name | SAMINA LONG
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Credential | LPC, LCDC
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Telephone | 405-249-3386
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 72046
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License Number State | TX
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