MEDICARE: COUNSELING RESOURCE CENTER, PLLC

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	61425	TX

General Provider Information

NPI Number	:	1073770921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING RESOURCE CENTER, PLLC

Provider Business Mailing Address
First Line	:	111 HOUSTON ST
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4759
Country	:	US
Telephone Number	:	281-255-9922
Fax Number	:	281-255-9064

Provider Business Practice Location Address
First Line	:	111 HOUSTON ST
Second Line	:
City	:	TOMBALL
State	:	TX
Zip	:	77375-4759
Country	:	US
Telephone Number	:	281-255-9922
Fax Number	:	281-255-9064

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. ANN MARIE BOLTON
Credential	:	LPC
Telephone Number	:	281-255-9922

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	09/22/2011

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