Provider Demographics
NPI:1700540382
Name:BLUE AGAVE COUNSELING, PLLC
Entity Type:Organization
Organization Name:BLUE AGAVE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MEIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHREINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:346-457-5655
Mailing Address - Street 1:PO BOX 130292
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77393-0292
Mailing Address - Country:US
Mailing Address - Phone:346-457-5655
Mailing Address - Fax:346-457-5644
Practice Address - Street 1:903 HONEA EGYPT RD # A-2
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2754
Practice Address - Country:US
Practice Address - Phone:346-457-5655
Practice Address - Fax:346-457-5644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health