Provider Demographics
NPI: | 1750190724 |
---|---|
Name: | INNOVA COUNSELING SERVICES PLLC |
Entity type: | Organization |
Organization Name: | INNOVA COUNSELING SERVICES PLLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER/COUNSELOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | NANCY |
Authorized Official - Middle Name: | E |
Authorized Official - Last Name: | JIMENEZ-MOTA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 682-325-1222 |
Mailing Address - Street 1: | 203 FLUSHING QUAIL DR |
Mailing Address - Street 2: | |
Mailing Address - City: | ARLINGTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 76002-3357 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 682-325-1222 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3901 ARLINGTON HIGHLANDS BLVD STE 200 |
Practice Address - Street 2: | |
Practice Address - City: | ARLINGTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 76018-6050 |
Practice Address - Country: | US |
Practice Address - Phone: | 682-325-1222 |
Practice Address - Fax: | 682-316-9295 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-01-04 |
Last Update Date: | 2025-01-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |