Provider Demographics
NPI:1063867265
Name:RGV COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:RGV COUNSELING SERVICES PLLC
Other - Org Name:SOUTH TEXAS COUNSELING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:GONZALEZ
Authorized Official - Last Name:BALLESTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-369-7997
Mailing Address - Street 1:1216 W FERN AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3933
Mailing Address - Country:US
Mailing Address - Phone:956-369-7997
Mailing Address - Fax:805-283-8480
Practice Address - Street 1:5401 N 10TH ST
Practice Address - Street 2:SUITE 124
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2751
Practice Address - Country:US
Practice Address - Phone:956-369-7997
Practice Address - Fax:805-283-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67293101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302282401Medicaid