Provider Demographics
NPI:1699421313
Name:SECRET SELF COUNSELING, PLLC
Entity type:Organization
Organization Name:SECRET SELF COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:FIONA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUNIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:737-201-3235
Mailing Address - Street 1:14801 RONALD W REAGAN BLVD APT 4307
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-4643
Mailing Address - Country:US
Mailing Address - Phone:512-658-9630
Mailing Address - Fax:
Practice Address - Street 1:14801 RONALD W REAGAN BLVD APT 4307
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-4643
Practice Address - Country:US
Practice Address - Phone:512-658-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty