Provider Demographics
NPI:1366032120
Name:MEMMS COUNSELING
Entity Type:Organization
Organization Name:MEMMS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WALTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCDC
Authorized Official - Phone:817-893-0994
Mailing Address - Street 1:PO BOX 152315
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-8315
Mailing Address - Country:US
Mailing Address - Phone:817-893-0994
Mailing Address - Fax:
Practice Address - Street 1:1011 GIBBINS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5615
Practice Address - Country:US
Practice Address - Phone:817-893-0994
Practice Address - Fax:866-794-6328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty