Provider Demographics
NPI:1184031551
Name:SLATE, GENEVIA RAYLENE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIA
Middle Name:RAYLENE
Last Name:SLATE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9460 W WESTRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79764-8923
Mailing Address - Country:US
Mailing Address - Phone:432-425-6978
Mailing Address - Fax:432-366-0880
Practice Address - Street 1:1901 E 37TH ST STE 111E
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-6216
Practice Address - Country:US
Practice Address - Phone:432-425-6978
Practice Address - Fax:432-366-0880
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9780101YA0400X
TX69274101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)