Provider Demographics
NPI:1750324414
Name:THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
Entity Type:Organization
Organization Name:THE SAMARITAN PASTORAL COUNSELING CENTER OF AMARILLO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TWILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-353-1668
Mailing Address - Street 1:112 W 8TH AVE
Mailing Address - Street 2:SUITE 800
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79101-2399
Mailing Address - Country:US
Mailing Address - Phone:806-353-1668
Mailing Address - Fax:806-353-1668
Practice Address - Street 1:112 W 8TH AVE
Practice Address - Street 2:SUITE 800
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2399
Practice Address - Country:US
Practice Address - Phone:806-353-1668
Practice Address - Fax:806-353-1668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096093203Medicaid
TX121937006Medicaid
TX148080802Medicaid
TX290635601Medicaid
TX177927401Medicaid
TX205124501Medicaid
TX028342601Medicaid
TX030722501Medicaid
TX161995901Medicaid
TX00614EMedicare PIN