Provider Demographics
NPI:1245828797
Name:START LOVING YOURSELF WELL COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:START LOVING YOURSELF WELL COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:LAVERN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:469-744-2693
Mailing Address - Street 1:828 TIMBER DELL LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75232-2046
Mailing Address - Country:US
Mailing Address - Phone:469-744-2693
Mailing Address - Fax:
Practice Address - Street 1:2025 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-4516
Practice Address - Country:US
Practice Address - Phone:972-224-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)