Provider Demographics
NPI:1104494541
Name:EARLE, DONNA GERMINO (MA, LPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:GERMINO
Last Name:EARLE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:GERMINO
Other - Last Name:EARLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:401 N. CARROLL AVENUE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092
Mailing Address - Country:US
Mailing Address - Phone:214-336-4933
Mailing Address - Fax:
Practice Address - Street 1:3217 WILBARGER TRL
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-3331
Practice Address - Country:US
Practice Address - Phone:214-336-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82783101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82783OtherTEXAS STATE OF EXAMINERS OF PROFESSIONAL COUNSELORS