Provider Demographics
NPI:1003422114
Name:INFINITE POTENTIAL COUNSELING, INC
Entity Type:Organization
Organization Name:INFINITE POTENTIAL COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-230-3740
Mailing Address - Street 1:1000 GATTIS SCHOOL RD STE 410
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2569
Mailing Address - Country:US
Mailing Address - Phone:512-230-3740
Mailing Address - Fax:
Practice Address - Street 1:1000 GATTIS SCHOOL RD STE 410
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2569
Practice Address - Country:US
Practice Address - Phone:512-230-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003254Medicaid