Provider Demographics
NPI:1578248944
Name:JOHN WAYNE COUNSELING, LLC
Entity Type:Organization
Organization Name:JOHN WAYNE COUNSELING, LLC
Other - Org Name:BRAVE MINDS COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-299-7303
Mailing Address - Street 1:608 E MILAM ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-6040
Mailing Address - Country:US
Mailing Address - Phone:830-299-7303
Mailing Address - Fax:833-520-1508
Practice Address - Street 1:608 E MILAM ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-6040
Practice Address - Country:US
Practice Address - Phone:830-299-7303
Practice Address - Fax:833-520-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty