Provider Demographics
NPI:1083441216
Name:PEBBLE PATH COUNSELING LLC
Entity type:Organization
Organization Name:PEBBLE PATH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:805-234-4493
Mailing Address - Street 1:3130 N HARWOOD ST APT 2606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1140
Mailing Address - Country:US
Mailing Address - Phone:805-234-4493
Mailing Address - Fax:
Practice Address - Street 1:5600 W LOVERS LANE
Practice Address - Street 2:SUITE 116 # 158
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209
Practice Address - Country:US
Practice Address - Phone:805-234-4493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty