Provider Demographics
NPI:1720362122
Name:CENTER FOR INDIVIDUAL AND FAMILY COUNSELING
Entity Type:Organization
Organization Name:CENTER FOR INDIVIDUAL AND FAMILY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:361-945-5840
Mailing Address - Street 1:3833 S STAPLES ST
Mailing Address - Street 2:N206
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-5201
Mailing Address - Country:US
Mailing Address - Phone:361-945-5840
Mailing Address - Fax:
Practice Address - Street 1:3833 S STAPLES ST
Practice Address - Street 2:N206
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5201
Practice Address - Country:US
Practice Address - Phone:361-945-5840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62777251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health