Provider Demographics
NPI:1043729072
Name:360 COACHING & COUNSELING
Entity Type:Organization
Organization Name:360 COACHING & COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-490-5162
Mailing Address - Street 1:302 W RED BIRD LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-2134
Mailing Address - Country:US
Mailing Address - Phone:580-471-3850
Mailing Address - Fax:
Practice Address - Street 1:375 MUNICIPAL DR STE 232
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3624
Practice Address - Country:US
Practice Address - Phone:214-490-5162
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIANA F RYAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-21
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12314101YA0400X
TX69073101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3439275-01Medicaid