Provider Demographics
NPI:1134423577
Name:ASCENSION COUNSELING AND WELLNESS SERVICES, PLLC
Entity type:Organization
Organization Name:ASCENSION COUNSELING AND WELLNESS SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:LISETTE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC
Authorized Official - Phone:915-227-4550
Mailing Address - Street 1:440 ROYAL CROWN RD
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-2112
Mailing Address - Country:US
Mailing Address - Phone:915-227-4550
Mailing Address - Fax:
Practice Address - Street 1:440 ROYAL CROWN RD
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-2112
Practice Address - Country:US
Practice Address - Phone:915-227-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-28
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16481101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12179275OtherCAQH
TX02985004Medicaid