Provider Demographics
NPI:1699076026
Name:PROFESSIONAL COUNSELING SERVICES OF NETX
Entity type:Organization
Organization Name:PROFESSIONAL COUNSELING SERVICES OF NETX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-268-3878
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-0048
Mailing Address - Country:US
Mailing Address - Phone:903-268-3878
Mailing Address - Fax:903-587-3101
Practice Address - Street 1:205 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-3113
Practice Address - Country:US
Practice Address - Phone:903-268-3878
Practice Address - Fax:903-587-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14952101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 102L00000X
TX17360101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216240602Medicaid
TX216240601Medicaid