Provider Demographics
NPI:1811484769
Name:FELLOWSHIP COUNSELING SERVICES
Entity type:Organization
Organization Name:FELLOWSHIP COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-994-9993
Mailing Address - Street 1:6843 BLUE GLADE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-5307
Mailing Address - Country:US
Mailing Address - Phone:281-994-9993
Mailing Address - Fax:
Practice Address - Street 1:6843 BLUE GLADE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5307
Practice Address - Country:US
Practice Address - Phone:281-994-9993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65402103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty