Provider Demographics
NPI:1124639489
Name:KINGWOOD COUNSELING CENTER PLLC
Entity type:Organization
Organization Name:KINGWOOD COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-347-8128
Mailing Address - Street 1:1521 GREEN OAK PL STE 250
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-2044
Mailing Address - Country:US
Mailing Address - Phone:281-608-1346
Mailing Address - Fax:832-436-1648
Practice Address - Street 1:1521 GREEN OAK PL STE 250
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2044
Practice Address - Country:US
Practice Address - Phone:281-608-1346
Practice Address - Fax:832-436-1648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty