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NPI Code Detail

MEDICARE: STAR COUNCIL

MEDICARE: STAR COUNCIL
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
1251S00000XCommunity/Behavioral Health Agency68618TX

General Provider Information

NPI Number : 1275807216
Entity Type Code : Organization
Provider Name (Legal Business Name) : STAR COUNCIL
Provider Business Mailing Address
First Line : 118 W HEARD ST
Second Line :
City : CLEBURNE
State : TX
Zip : 76033-3836
Country : US
Telephone Number : 817-645-5517
Fax Number : 817-645-5715
Provider Business Practice Location Address
First Line : 118 W HEARD ST
Second Line :
City : CLEBURNE
State : TX
Zip : 76033-3836
Country : US
Telephone Number : 817-645-5517
Fax Number : 817-645-5715
Authorized Official
Title or Position : COUNSELOR
Name : KELLY KRISTINE MCCOY
Credential : M.S., LPC-INTERN
Telephone Number : 817-501-7098
Provider Enumeration Date : 03/07/2012
Last Update Date : 03/07/2012

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Directions to “STAR COUNCIL ” Practice Location

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