Provider Demographics
NPI:1689758377
Name:COUNSELING SERVICES OF PITTSBURG
Entity Type:Organization
Organization Name:COUNSELING SERVICES OF PITTSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:903-856-6001
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75451-0351
Mailing Address - Country:US
Mailing Address - Phone:903-856-6001
Mailing Address - Fax:903-856-0465
Practice Address - Street 1:200 W MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:TX
Practice Address - Zip Code:75686-1348
Practice Address - Country:US
Practice Address - Phone:903-856-6001
Practice Address - Fax:903-856-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12451101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467300-01Medicaid