MEDICARE: THE KIDS COUNSELOR

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	65841	TX

General Provider Information

NPI Number	:	1073999025
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE KIDS COUNSELOR

Provider Business Mailing Address
First Line	:	505 UNIVERSITY DR E
Second Line	:	STE. 501
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5901
Country	:	US
Telephone Number	:	979-571-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 UNIVERSITY DR E
Second Line	:	STE. 501
City	:	COLLEGE STATION
State	:	TX
Zip	:	77840-5901
Country	:	US
Telephone Number	:	979-571-8857
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	VANESSA WATTS
Credential	:	MS, RN, LPC
Telephone Number	:	979-571-8857

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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Directions to “THE KIDS COUNSELOR ” Practice Location

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