Provider Demographics
NPI:1598371221
Name:MENDING BROKEN PIECES COUNSELING & CONSULTING SERVICES
Entity Type:Organization
Organization Name:MENDING BROKEN PIECES COUNSELING & CONSULTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELODI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, NCC
Authorized Official - Phone:469-518-6034
Mailing Address - Street 1:1229 E PLEASANT RUN RD STE 305
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4229
Mailing Address - Country:US
Mailing Address - Phone:469-518-6034
Mailing Address - Fax:469-375-3981
Practice Address - Street 1:1229 E PLEASANT RUN RD STE 305
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4229
Practice Address - Country:US
Practice Address - Phone:469-518-6034
Practice Address - Fax:469-375-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty