Provider Demographics
NPI:1518596113
Name:CHISHOLM TRAIL E-THERAPY AND COUNSELING, PLLC
Entity Type:Organization
Organization Name:CHISHOLM TRAIL E-THERAPY AND COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / LPC
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKYTA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:682-231-1725
Mailing Address - Street 1:5025 CHISHOLM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1576
Mailing Address - Country:US
Mailing Address - Phone:772-267-8219
Mailing Address - Fax:
Practice Address - Street 1:5025 CHISHOLM VIEW DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-1576
Practice Address - Country:US
Practice Address - Phone:772-267-8219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty