Provider Demographics
NPI:1811693153
Name:M&T COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:M&T COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SHOULARS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MPA, LCMHC, NCC
Authorized Official - Phone:252-676-2656
Mailing Address - Street 1:46 CAMDEN COURT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870
Mailing Address - Country:US
Mailing Address - Phone:252-676-2656
Mailing Address - Fax:
Practice Address - Street 1:608 JACKSON ST STE 216
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-2600
Practice Address - Country:US
Practice Address - Phone:252-676-2656
Practice Address - Fax:252-541-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-07
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health