Provider Demographics
NPI:1083263677
Name:FRESH START EAST TEXAS COUNSELING SERVICES
Entity Type:Organization
Organization Name:FRESH START EAST TEXAS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-510-2188
Mailing Address - Street 1:1203 B E. GRAND AVE. #313
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670
Mailing Address - Country:US
Mailing Address - Phone:903-930-1008
Mailing Address - Fax:
Practice Address - Street 1:202 S. ALAMO BLVD. SUITE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670
Practice Address - Country:US
Practice Address - Phone:903-930-1008
Practice Address - Fax:903-930-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management