Provider Demographics
NPI:1811186091
Name:PROFESSIONAL EDUCATION & GROWTH SERVICES
Entity Type:Organization
Organization Name:PROFESSIONAL EDUCATION & GROWTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-276-6412
Mailing Address - Street 1:301 S CENTER ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-7139
Mailing Address - Country:US
Mailing Address - Phone:817-276-6412
Mailing Address - Fax:817-276-6438
Practice Address - Street 1:301 S CENTER ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-7139
Practice Address - Country:US
Practice Address - Phone:817-276-6412
Practice Address - Fax:817-276-6438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12623251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health