Provider Demographics
NPI:1154722908
Name:164 COUNSELING SERVICES
Entity type:Organization
Organization Name:164 COUNSELING SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-934-8844
Mailing Address - Street 1:5526 DYER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5031
Mailing Address - Country:US
Mailing Address - Phone:214-934-8844
Mailing Address - Fax:
Practice Address - Street 1:701 NE 5TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:HUBBARD
Practice Address - State:TX
Practice Address - Zip Code:76648-2203
Practice Address - Country:US
Practice Address - Phone:254-576-1040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3775-3776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty