Provider Demographics
NPI:1659782878
Name:MANSFIELD COUNSELING
Entity Type:Organization
Organization Name:MANSFIELD COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-952-2324
Mailing Address - Street 1:1285 N MAIN STREET
Mailing Address - Street 2:SUITE 101-10
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1511
Mailing Address - Country:US
Mailing Address - Phone:214-952-2324
Mailing Address - Fax:214-572-2986
Practice Address - Street 1:1285 N MAIN STREET
Practice Address - Street 2:SUITE 101-10
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1511
Practice Address - Country:US
Practice Address - Phone:214-952-2324
Practice Address - Fax:214-572-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61332101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty