Provider Demographics
NPI:1780791079
Name:COUNSELING AND CONSULTING ASSOCIATES OF CENTRAL TEXAS
Entity type:Organization
Organization Name:COUNSELING AND CONSULTING ASSOCIATES OF CENTRAL TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:M ED, LPC, LCDC
Authorized Official - Phone:254-405-1338
Mailing Address - Street 1:770 BOSQUE LN
Mailing Address - Street 2:
Mailing Address - City:MC GREGOR
Mailing Address - State:TX
Mailing Address - Zip Code:76657-3401
Mailing Address - Country:US
Mailing Address - Phone:254-405-1338
Mailing Address - Fax:254-772-6118
Practice Address - Street 1:770 BOSQUE LN
Practice Address - Street 2:
Practice Address - City:MC GREGOR
Practice Address - State:TX
Practice Address - Zip Code:76657-3401
Practice Address - Country:US
Practice Address - Phone:254-405-1338
Practice Address - Fax:254-772-6118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9836101YA0400X
TX6993101YA0400X
TX9805101YA0400X
TX18454101YP2500X
TX19676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty