Provider Demographics
NPI:1134622863
Name:EBONY CENTER PLLC
Entity type:Organization
Organization Name:EBONY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:956-546-6100
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:LOS FRESNOS
Mailing Address - State:TX
Mailing Address - Zip Code:78566
Mailing Address - Country:US
Mailing Address - Phone:956-546-6100
Mailing Address - Fax:877-808-8344
Practice Address - Street 1:2905 CENTRAL BLVD.
Practice Address - Street 2:SUITE C
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-546-6100
Practice Address - Fax:877-808-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty