Provider Demographics
NPI:1194312322
Name:FOUR CORNERS COUNSELING, PLLC
Entity type:Organization
Organization Name:FOUR CORNERS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-368-0633
Mailing Address - Street 1:PO BOX 690642
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-0011
Mailing Address - Country:US
Mailing Address - Phone:254-368-0633
Mailing Address - Fax:
Practice Address - Street 1:1519 FLORENCE RD STE 14
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-7903
Practice Address - Country:US
Practice Address - Phone:254-368-0633
Practice Address - Fax:254-294-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty