Provider Demographics
NPI:1417483686
Name:LOVING YOURSELF WELL COUNSELING AGENCY
Entity Type:Organization
Organization Name:LOVING YOURSELF WELL COUNSELING AGENCY
Other - Org Name:KIMBERLY PEARSON DBA LOVING YOURSELF WELL COUNSELING AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-744-2693
Mailing Address - Street 1:828 TIMBER DELL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232
Mailing Address - Country:US
Mailing Address - Phone:469-744-2693
Mailing Address - Fax:
Practice Address - Street 1:1633 EXETER AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-6305
Practice Address - Country:US
Practice Address - Phone:469-744-2693
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73002251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health