Provider Demographics
NPI:1639633233
Name:DIAGNOSTIC AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:DIAGNOSTIC AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:ROLDAN-BALBOA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:469-685-3572
Mailing Address - Street 1:8035 ERL THORNTON FREEWAY
Mailing Address - Street 2:455
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-7084
Mailing Address - Country:US
Mailing Address - Phone:469-685-3572
Mailing Address - Fax:
Practice Address - Street 1:8035 ERL THORNTON FREEWAY
Practice Address - Street 2:107
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-7084
Practice Address - Country:US
Practice Address - Phone:214-720-1833
Practice Address - Fax:214-979-0593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1376084046OtherMEDICIAD