MEDICARE: WOODNOTE 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	101YM0800X	Mental Health Counselor	63471	TX

General Provider Information

NPI Number	:	1578094017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODNOTE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	12816 WILLOW CENTRE DR STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3034
Country	:	US
Telephone Number	:	346-235-3939
Fax Number	:	346-235-3938

Provider Business Practice Location Address
First Line	:	12816 WILLOW CENTRE DR STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-3034
Country	:	US
Telephone Number	:	346-235-3939
Fax Number	:	346-235-3938

Authorized Official
Title or Position	:	OWNER
Name	:	GLORIA AURORA CHAMPION
Credential	:	LPC
Telephone Number	:	346-235-3939

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	03/27/2017

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