Provider Demographics
NPI:1740712025
Name:FORT BEND COUNSELING AND PSYCHOTHERAPY
Entity type:Organization
Organization Name:FORT BEND COUNSELING AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:HELAINE
Authorized Official - Last Name:MATALLANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-231-8858
Mailing Address - Street 1:4501 CARTWRIGHT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-3537
Mailing Address - Country:US
Mailing Address - Phone:713-231-8858
Mailing Address - Fax:281-302-5401
Practice Address - Street 1:4501 CARTWRIGHT RD STE 103
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-3537
Practice Address - Country:US
Practice Address - Phone:713-231-8858
Practice Address - Fax:281-302-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX352471041C0700X
TX342201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty