Provider Demographics
NPI:1235395229
Name:GEORGETOWN COUNSELING SERVICES
Entity Type:Organization
Organization Name:GEORGETOWN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-773-6402
Mailing Address - Street 1:624 S AUSTIN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5707
Mailing Address - Country:US
Mailing Address - Phone:512-869-1152
Mailing Address - Fax:512-869-1145
Practice Address - Street 1:624 S AUSTIN AVE
Practice Address - Street 2:STE 220
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5707
Practice Address - Country:US
Practice Address - Phone:512-869-1152
Practice Address - Fax:512-869-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4265101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
455585OtherVALUE OPTIONS
TX0077GDOtherBLUE CROSS AND BLUE SHIELD