Provider Demographics
NPI:1790949964
Name:AMARILLO COUNSELING ASSOCIATES @ WESLEY COMMUNITY CENTER
Entity Type:Organization
Organization Name:AMARILLO COUNSELING ASSOCIATES @ WESLEY COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:806-372-7960
Mailing Address - Street 1:1615 S ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-4330
Mailing Address - Country:US
Mailing Address - Phone:806-372-1092
Mailing Address - Fax:806-372-7868
Practice Address - Street 1:1615 S ROBERTS ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-4330
Practice Address - Country:US
Practice Address - Phone:806-372-1092
Practice Address - Fax:806-372-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12345101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83811LOtherBLUECROSS BLUESHIELD OF TEXAS
TX0261737-01Medicaid