MEDICARE: THE WOODLANDS CHRISTIAN COUNSELING CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	14391	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1811908635	OTHER	TX	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1023203254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOODLANDS CHRISTIAN COUNSELING CENTER, INC.

Provider Business Mailing Address
First Line	:	32826 CRESTLAKE BLVD
Second Line	:
City	:	MAGNOLIA
State	:	TX
Zip	:	77354-3234
Country	:	US
Telephone Number	:	281-750-6078
Fax Number	:	281-252-3507

Provider Business Practice Location Address
First Line	:	25325 BOROUGH PARK DR
Second Line	:	SUITE 220
City	:	THE WOODLANDS
State	:	TX
Zip	:	77380-3569
Country	:	US
Telephone Number	:	281-750-6078
Fax Number	:	281-252-3507

Authorized Official
Title or Position	:	PROFESSIONAL COUNSELLOR
Name	:	PROF. LAURIE M ABLES
Credential	:	MA, LPC, NCC
Telephone Number	:	281-750-6078

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	04/20/2008

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