MEDICARE: HEAVENLY 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	74513	OTHER	TX	LPC LICENSE

General Provider Information

NPI Number	:	1699307405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY COUNSELING PLLC

Provider Business Mailing Address
First Line	:	2201 SPINKS RD STE 118
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4451
Country	:	US
Telephone Number	:	214-436-2272
Fax Number	:	469-464-9924

Provider Business Practice Location Address
First Line	:	2201 SPINKS RD STE 118
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4451
Country	:	US
Telephone Number	:	214-436-2272
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ALEXANDR PHILIP
Credential	:	LPC
Telephone Number	:	214-436-2272

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	03/12/2026

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