Provider Demographics
NPI:1588449680
Name:SIXBERRY COUNSELING SERVICES
Entity type:Organization
Organization Name:SIXBERRY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:SIXBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:336-663-1554
Mailing Address - Street 1:2601 OAKCREST AVE STE F
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4719
Mailing Address - Country:US
Mailing Address - Phone:336-663-1554
Mailing Address - Fax:336-715-5120
Practice Address - Street 1:2601 OAKCREST AVE STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4719
Practice Address - Country:US
Practice Address - Phone:336-663-1554
Practice Address - Fax:336-715-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)