Provider Demographics
NPI:1801400726
Name:FRESH START EAST TEXAS COUNSELING SERVICES
Entity Type:Organization
Organization Name:FRESH START EAST TEXAS COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-510-2188
Mailing Address - Street 1:1203B E GRAND AVE # 313
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-3562
Mailing Address - Country:US
Mailing Address - Phone:903-930-1008
Mailing Address - Fax:903-930-1008
Practice Address - Street 1:202 S ALAMO BLVD STE A
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-4259
Practice Address - Country:US
Practice Address - Phone:903-930-1008
Practice Address - Fax:903-930-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health