Provider Demographics
NPI:1134962319
Name:HTTPS://NPPES.CMS.HHS.GOV/IAWEB/LOGIN.DO
Entity type:Organization
Organization Name:HTTPS://NPPES.CMS.HHS.GOV/IAWEB/LOGIN.DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:SHARYN
Authorized Official - Last Name:COUSAR
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-591-7305
Mailing Address - Street 1:703 S CHURCH ST BLDG 2
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5749
Mailing Address - Country:US
Mailing Address - Phone:254-258-3769
Mailing Address - Fax:
Practice Address - Street 1:703 S CHURCH ST BLDG 2
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5749
Practice Address - Country:US
Practice Address - Phone:512-591-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health