Provider Demographics
NPI:1821650573
Name:MONTGOMERY COUNTY COUNSELING WORKS, PLLC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY COUNSELING WORKS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST AND OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC
Authorized Official - Phone:979-235-0447
Mailing Address - Street 1:124 MALLARD CREEK CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77316-1868
Mailing Address - Country:US
Mailing Address - Phone:979-235-0447
Mailing Address - Fax:
Practice Address - Street 1:25511 BUDDE RD STE 3601
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-2080
Practice Address - Country:US
Practice Address - Phone:979-235-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1104354828OtherSOLE PROPRIETER
TX1104354828Medicaid