Provider Demographics
NPI:1750603924
Name:INNER-CHILD COUNSELING AND ASSOCIATES, LLC
Entity type:Organization
Organization Name:INNER-CHILD COUNSELING AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BYAS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-931-1409
Mailing Address - Street 1:705 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-2352
Mailing Address - Country:US
Mailing Address - Phone:254-931-1409
Mailing Address - Fax:254-840-4449
Practice Address - Street 1:5700 E CENTEX EXPY
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76543-5505
Practice Address - Country:US
Practice Address - Phone:254-931-1410
Practice Address - Fax:254-840-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty