Provider Demographics
NPI:1275807216
Name:STAR COUNCIL
Entity Type:Organization
Organization Name:STAR COUNCIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC-INTERN
Authorized Official - Phone:817-501-7098
Mailing Address - Street 1:118 W HEARD ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3836
Mailing Address - Country:US
Mailing Address - Phone:817-645-5517
Mailing Address - Fax:817-645-5715
Practice Address - Street 1:118 W HEARD ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3836
Practice Address - Country:US
Practice Address - Phone:817-645-5517
Practice Address - Fax:817-645-5715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68618251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health