Provider Demographics
NPI:1790031060
Name:FAMILY TREE COUNSELING, PLLC
Entity Type:Organization
Organization Name:FAMILY TREE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTILIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-363-6264
Mailing Address - Street 1:18619 REMBRANDT TER
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3409
Mailing Address - Country:US
Mailing Address - Phone:469-363-6264
Mailing Address - Fax:
Practice Address - Street 1:5309 VILLAGE CREEK DR
Practice Address - Street 2:#100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4841
Practice Address - Country:US
Practice Address - Phone:469-443-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61514251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health