Provider Demographics
NPI:1578781928
Name:HEARTLAND COUNSELING OF SOUTH TEXAS, INC.
Entity Type:Organization
Organization Name:HEARTLAND COUNSELING OF SOUTH TEXAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:PHILLIPS
Authorized Official - Last Name:LANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-241-3600
Mailing Address - Street 1:3153 MCKINZIE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-2630
Mailing Address - Country:US
Mailing Address - Phone:361-241-3600
Mailing Address - Fax:361-241-3600
Practice Address - Street 1:3153 MCKINZIE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2630
Practice Address - Country:US
Practice Address - Phone:361-241-3600
Practice Address - Fax:361-241-3600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1527483-01Medicaid