MEDICARE: WHOLISTIC CHRISTIAN COUNSELING CENTER

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	302F00000X	Exclusive Provider Organization	809	TX
2	106H00000X	Marriage & Family Therapist	2994	TX

General Provider Information

NPI Number	:	1881870533
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC CHRISTIAN COUNSELING CENTER

Provider Business Mailing Address
First Line	:	PO BOX 8284
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77288-8284
Country	:	US
Telephone Number	:	713-218-7898
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 S LOOP W
Second Line	:	STE. 220
City	:	HOUSTON
State	:	TX
Zip	:	77054-2653
Country	:	US
Telephone Number	:	713-218-7898
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTHA WASHINGTON VAUGHN
Credential	:
Telephone Number	:	713-218-7898

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	10/15/2008

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