Provider Demographics
NPI:1275850349
Name:SERENITY PLACE COUNSELING LLC
Entity Type:Organization
Organization Name:SERENITY PLACE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHIRMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:817-219-1726
Mailing Address - Street 1:806 OLD CLEBURNE RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-1422
Mailing Address - Country:US
Mailing Address - Phone:817-579-9559
Mailing Address - Fax:800-392-2104
Practice Address - Street 1:806 OLD CLEBURNE RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1422
Practice Address - Country:US
Practice Address - Phone:817-579-9559
Practice Address - Fax:800-392-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15770101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1599607-01Medicaid