Provider Demographics
NPI:1497419527
Name:STONEBRIDGE INDEPENDENT COUNSELING CENTER
Entity Type:Organization
Organization Name:STONEBRIDGE INDEPENDENT COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-252-7090
Mailing Address - Street 1:3128 HUDSON XING STE 1
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6556
Mailing Address - Country:US
Mailing Address - Phone:469-252-7090
Mailing Address - Fax:469-617-7052
Practice Address - Street 1:3128 HUDSON XING STE 1
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6556
Practice Address - Country:US
Practice Address - Phone:469-252-7090
Practice Address - Fax:469-617-7052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty