Provider Demographics
NPI:1619334588
Name:BRUISED APPLES MENTORING PROGRAM
Entity Type:Organization
Organization Name:BRUISED APPLES MENTORING PROGRAM
Other - Org Name:BRUISED APPLES HOLISTIC COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:ELLERBE
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:832-512-0355
Mailing Address - Street 1:PO BOX 152292
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-2292
Mailing Address - Country:US
Mailing Address - Phone:832-512-0355
Mailing Address - Fax:
Practice Address - Street 1:2101 E BEN WHITE BLVD
Practice Address - Street 2:BUILDING 8, SUITE 800
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6922
Practice Address - Country:US
Practice Address - Phone:832-512-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty