Provider Demographics
NPI:1336412139
Name:CENTEX LPC
Entity Type:Organization
Organization Name:CENTEX LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAVANNAH
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:512-709-6475
Mailing Address - Street 1:208 E. CENTRAL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-3213
Mailing Address - Country:US
Mailing Address - Phone:512-709-6475
Mailing Address - Fax:
Practice Address - Street 1:208 E CENTRAL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-3205
Practice Address - Country:US
Practice Address - Phone:512-709-6475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65331101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1043504434Medicaid