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NPI Code Detail

MEDICARE: TAPESTRY COUNSELING OF EAST TEXAS

MEDICARE: TAPESTRY COUNSELING OF EAST TEXAS
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
1106H00000XMarriage & Family Therapist
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1659887115
Entity Type Code : Organization
Provider Name (Legal Business Name) : TAPESTRY COUNSELING OF EAST TEXAS
Provider Business Mailing Address
First Line : 17121 HIGHWAY 69 S
Second Line :
City : TYLER
State : TX
Zip : 75703-8091
Country : US
Telephone Number : 903-316-5711
Fax Number :
Provider Business Practice Location Address
First Line : 17121 HIGHWAY 69 S
Second Line :
City : TYLER
State : TX
Zip : 75703-8091
Country : US
Telephone Number : 903-316-5711
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : MR. HOWARD BRENT KIRKLEY
Credential : LPC
Telephone Number : 903-361-5711
Provider Enumeration Date : 12/20/2017
Last Update Date : 12/20/2017

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1669088134 — LAUREN PEACOCK MA, LPC
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Practice Fax:
1235725763 — MRS. REBECCA SCHALL LPC
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Directions to “TAPESTRY COUNSELING OF EAST TEXAS ” Practice Location

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