Provider Demographics
NPI:1548782782
Name:COGNIZANCE COUNSELING PSYCHOTHERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:COGNIZANCE COUNSELING PSYCHOTHERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN HORN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:432-208-3347
Mailing Address - Street 1:710 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2112
Mailing Address - Country:US
Mailing Address - Phone:432-208-3347
Mailing Address - Fax:
Practice Address - Street 1:14 E CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76501-7626
Practice Address - Country:US
Practice Address - Phone:432-208-3347
Practice Address - Fax:432-208-3347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64053101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty