Provider Demographics
NPI:1427742196
Name:CORDOVA COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:CORDOVA COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:CORDOVA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:936-371-1172
Mailing Address - Street 1:872 FM 2664
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1281
Mailing Address - Country:US
Mailing Address - Phone:936-679-3101
Mailing Address - Fax:866-598-3817
Practice Address - Street 1:115 N UNIVERSITY DR STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-5126
Practice Address - Country:US
Practice Address - Phone:936-371-1172
Practice Address - Fax:866-598-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty