Provider Demographics
NPI:1598314676
Name:EMBOLDEN COUNSELING COLLECTIVE PLLC
Entity Type:Organization
Organization Name:EMBOLDEN COUNSELING COLLECTIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERITE
Authorized Official - Middle Name:MERRISSA
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-825-3830
Mailing Address - Street 1:2189 CYPRESS CREEK PKWY STE 216
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-3100
Mailing Address - Country:US
Mailing Address - Phone:281-825-3830
Mailing Address - Fax:
Practice Address - Street 1:2189 CYPRESS CREEK PKWY STE 216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3100
Practice Address - Country:US
Practice Address - Phone:281-825-3830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty