Provider Demographics
NPI:1114379286
Name:FREE YOUR MIND PROFESSIONAL COUNSELING SERVICES,PLLC
Entity Type:Organization
Organization Name:FREE YOUR MIND PROFESSIONAL COUNSELING SERVICES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NAKEISHA
Authorized Official - Middle Name:QUIAN
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC-S/NCC
Authorized Official - Phone:832-850-6422
Mailing Address - Street 1:440 BENMAR DR
Mailing Address - Street 2:SUITE#1176
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3165
Mailing Address - Country:US
Mailing Address - Phone:832-850-6422
Mailing Address - Fax:832-850-7852
Practice Address - Street 1:440 BENMAR DR
Practice Address - Street 2:SUITE#1176
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3165
Practice Address - Country:US
Practice Address - Phone:832-850-6422
Practice Address - Fax:832-850-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty