Provider Demographics
NPI:1336813138
Name:R.E.S.T COUNSELING SERVICES
Entity Type:Organization
Organization Name:R.E.S.T COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DORIS
Authorized Official - Middle Name:FEROW
Authorized Official - Last Name:MIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-529-4745
Mailing Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77384-2212
Mailing Address - Country:US
Mailing Address - Phone:936-529-4745
Mailing Address - Fax:
Practice Address - Street 1:525 WOODLAND SQUARE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77384-2212
Practice Address - Country:US
Practice Address - Phone:936-529-4745
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568875698OtherNPI