MEDICARE: GENERATIONS PROFESSIONAL COUNSELING, 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	19670	TX

General Provider Information

NPI Number	:	1528576428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS PROFESSIONAL COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	207 S VAL VERDE CIR
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-1933
Country	:	US
Telephone Number	:	682-615-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 S VAL VERDE CIR
Second Line	:
City	:	KEENE
State	:	TX
Zip	:	76059-1933
Country	:	US
Telephone Number	:	682-615-2080
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MRS. AMY SHANTELE MILLS
Credential	:	LPC
Telephone Number	:	682-615-2080

Provider Enumeration Date	:	01/14/2018
Last Update Date	:	01/14/2018

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