Provider Demographics
NPI:1740410059
Name:SJCARDWELL COUNSELING & CONSULTING, PLLC
Entity Type:Organization
Organization Name:SJCARDWELL COUNSELING & CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,MA
Authorized Official - Phone:940-691-1267
Mailing Address - Street 1:2304 MIDWESTERN PKWY
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2342
Mailing Address - Country:US
Mailing Address - Phone:940-691-1267
Mailing Address - Fax:940-691-1582
Practice Address - Street 1:2304 MIDWESTERN PKWY
Practice Address - Street 2:SUITE 103A
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2342
Practice Address - Country:US
Practice Address - Phone:940-691-1267
Practice Address - Fax:940-691-1582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty