Provider Demographics
NPI:1770861221
Name:EXTRORDINARY COUNSELING
Entity Type:Organization
Organization Name:EXTRORDINARY COUNSELING
Other - Org Name:EXTRORDINARY COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ZYLPHIA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BEVERLY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S,LCDC,NCC
Authorized Official - Phone:210-632-8966
Mailing Address - Street 1:315 ASTORIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1601
Mailing Address - Country:US
Mailing Address - Phone:210-632-8966
Mailing Address - Fax:210-337-7850
Practice Address - Street 1:2803 E COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78203-2201
Practice Address - Country:US
Practice Address - Phone:210-632-8966
Practice Address - Fax:210-337-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9784101Y00000X, 101YM0800X, 101YP2500X, 106H00000X, 251S00000X
TX6238101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1750329124OtherNPI TYPE I
TX095707803Medicaid
TX095707804Medicaid
TX095707801Medicaid