Provider Demographics
NPI:1508067141
Name:SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
Entity Type:Organization
Organization Name:SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TWILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMFTA
Authorized Official - Phone:806-353-1668
Mailing Address - Street 1:3517 S MILAM ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-4824
Mailing Address - Country:US
Mailing Address - Phone:806-359-0277
Mailing Address - Fax:
Practice Address - Street 1:112 W 8TH AVE STE 800
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2399
Practice Address - Country:US
Practice Address - Phone:806-353-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12516251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health