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NPI Code Detail

MEDICARE: PANACHE COUNSELING GROUP, LLC

MEDICARE: PANACHE COUNSELING GROUP, LLC
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
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1760956627
Entity Type Code : Organization
Provider Name (Legal Business Name) : PANACHE COUNSELING GROUP, LLC
Provider Business Mailing Address
First Line : 1777 NE LOOP 410 STE 600
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78217-5218
Country : US
Telephone Number : 855-472-4552
Fax Number :
Provider Business Practice Location Address
First Line : 1777 NE LOOP 410 STE 600
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78217-5218
Country : US
Telephone Number : 855-472-4552
Fax Number :
Authorized Official
Title or Position : COUNSELOR
Name : DR. DEWANNA W GREER
Credential : EDD, LPC
Telephone Number : 318-791-2954
Provider Enumeration Date : 01/14/2019
Last Update Date : 01/14/2019

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