Provider Demographics
NPI:1417508169
Name:CANVAS COUNSELING AND WELLNESS PLLC
Entity Type:Organization
Organization Name:CANVAS COUNSELING AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & LICENSED PROFESSIONAL COUNS
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:HOGG
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, RPT
Authorized Official - Phone:214-307-2340
Mailing Address - Street 1:120 E GRUBB DR UNIT 852751
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-5130
Mailing Address - Country:US
Mailing Address - Phone:214-307-2340
Mailing Address - Fax:
Practice Address - Street 1:1401 N CENTRAL EXPY STE 120
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4669
Practice Address - Country:US
Practice Address - Phone:214-307-2340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-24
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty