Provider Demographics
NPI:1073834594
Name:COUNSELING PROFESSIONALS OF NORTHEAST TEXAS
Entity Type:Organization
Organization Name:COUNSELING PROFESSIONALS OF NORTHEAST TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONIKAYE
Authorized Official - Middle Name:JOPLIN
Authorized Official - Last Name:RUSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:903-785-0400
Mailing Address - Street 1:737 LAMAR AVENUE
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4479
Mailing Address - Country:US
Mailing Address - Phone:903-785-0400
Mailing Address - Fax:903-785-0403
Practice Address - Street 1:737 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4479
Practice Address - Country:US
Practice Address - Phone:903-785-0400
Practice Address - Fax:903-785-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty