Provider Demographics
NPI:1093348443
Name:SOUTHEAST TEXAS COUNSELING & ASSESSMENT SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS COUNSELING & ASSESSMENT SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:409-504-4596
Mailing Address - Street 1:11126 GAULDING RD
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-9440
Mailing Address - Country:US
Mailing Address - Phone:409-504-4596
Mailing Address - Fax:409-220-6456
Practice Address - Street 1:2626 CALDER ST STE 204
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1926
Practice Address - Country:US
Practice Address - Phone:409-504-4596
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409773501Medicaid