Provider Demographics
NPI:1760844195
Name:SPIRIT CHRISTIAN COUNSELING CENTERS, INC.
Entity Type:Organization
Organization Name:SPIRIT CHRISTIAN COUNSELING CENTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEOS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LMFT, NCC
Authorized Official - Phone:469-660-8620
Mailing Address - Street 1:1420 W EXCHANGE PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4670
Mailing Address - Country:US
Mailing Address - Phone:469-660-8620
Mailing Address - Fax:
Practice Address - Street 1:1420 W EXCHANGE PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-4670
Practice Address - Country:US
Practice Address - Phone:469-660-8620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63241101YP2500X
TX201213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty