Provider Demographics
NPI:1104345248
Name:WONDERFULLY MADE YOU COUNSELING, P.C.
Entity type:Organization
Organization Name:WONDERFULLY MADE YOU COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDE
Authorized Official - Middle Name:
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-723-5421
Mailing Address - Street 1:17110 HOLLY FALLS CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-4208
Mailing Address - Country:US
Mailing Address - Phone:254-723-5421
Mailing Address - Fax:
Practice Address - Street 1:16903 RED OAK DR STE 213
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3915
Practice Address - Country:US
Practice Address - Phone:254-723-5421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-10
Last Update Date:2017-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71838101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX347855401Medicaid