Provider Demographics
NPI:1003492570
Name:PURPLE CRAYON COUNSELING, PLLC
Entity Type:Organization
Organization Name:PURPLE CRAYON COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:NELIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-287-0646
Mailing Address - Street 1:10845 COUNTY ROAD 429
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-3813
Mailing Address - Country:US
Mailing Address - Phone:903-714-4991
Mailing Address - Fax:
Practice Address - Street 1:401 E FRONT ST STE 227
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8219
Practice Address - Country:US
Practice Address - Phone:903-287-0646
Practice Address - Fax:903-560-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405322501Medicaid