Provider Demographics
NPI:1396874103
Name:HENNEBURG COUNSELING CENTER, P. C.
Entity type:Organization
Organization Name:HENNEBURG COUNSELING CENTER, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTEFANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VENEGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-778-3807
Mailing Address - Street 1:6090 SURETY DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905-2060
Mailing Address - Country:US
Mailing Address - Phone:915-778-3807
Mailing Address - Fax:915-779-6600
Practice Address - Street 1:6090 SURETY DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2060
Practice Address - Country:US
Practice Address - Phone:915-778-3807
Practice Address - Fax:915-779-6600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2088-A261QR0405X
TX13071101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146664101Medicaid