Provider Demographics
NPI:1477829026
Name:FAMILY & PASTORAL COUNSELING CENTER PLLC
Entity Type:Organization
Organization Name:FAMILY & PASTORAL COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SWINHOE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:940-386-9378
Mailing Address - Street 1:2629 PLAZA PKWY
Mailing Address - Street 2:SUITE A-3
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3885
Mailing Address - Country:US
Mailing Address - Phone:940-386-9378
Mailing Address - Fax:940-386-9379
Practice Address - Street 1:2629 PLAZA PKWY
Practice Address - Street 2:SUITE A-3
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-3885
Practice Address - Country:US
Practice Address - Phone:940-386-9378
Practice Address - Fax:940-386-9379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8070BHOtherBCBS
TX028939901Medicaid