Provider Demographics
NPI:1053855932
Name:CENTRAL TEXAS COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL TEXAS COUNSELING ASSOCIATES
Other - Org Name:PROFESSIONAL COUNSELING SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:254-526-7272
Mailing Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 103
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541-9145
Mailing Address - Country:US
Mailing Address - Phone:254-526-7272
Mailing Address - Fax:254-526-3949
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 103
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9145
Practice Address - Country:US
Practice Address - Phone:254-526-7272
Practice Address - Fax:254-526-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-12
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10114101YP2500X
TX526911041C0700X
TX620961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2041428Medicaid
TX2041428Medicaid