Provider Demographics
NPI:1134330392
Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF EAST TEXAS, PC
Entity Type:Organization
Organization Name:COUNSELING AND PSYCHOLOGICAL SERVICES OF EAST TEXAS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHARLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:903-938-4476
Mailing Address - Street 1:PO BOX 8317
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75671-8317
Mailing Address - Country:US
Mailing Address - Phone:903-938-4476
Mailing Address - Fax:903-938-4125
Practice Address - Street 1:301 N WELLINGTON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-3335
Practice Address - Country:US
Practice Address - Phone:903-938-4476
Practice Address - Fax:903-938-4125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146704502Medicaid
TX00792RMedicare ID - Type Unspecified