Provider Demographics
NPI:1477198141
Name:NORTHEAST COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:NORTHEAST COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:AGUERO
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:903-283-4405
Mailing Address - Street 1:12915 JONES MALTSBERGER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4540
Mailing Address - Country:US
Mailing Address - Phone:210-404-4317
Mailing Address - Fax:210-817-8722
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4540
Practice Address - Country:US
Practice Address - Phone:210-404-4317
Practice Address - Fax:210-817-8722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-16
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX408501101Medicaid