Provider Demographics
| NPI: | 1811787476 |
|---|---|
| Name: | 3:30 COUNSELING & PSYCHOLOGICAL SERVICES PLLC |
| Entity type: | Organization |
| Organization Name: | 3:30 COUNSELING & PSYCHOLOGICAL SERVICES PLLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | LPC, LSSP, OWNER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | LISA |
| Authorized Official - Middle Name: | MARIE |
| Authorized Official - Last Name: | DANIEL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | PHD, LPC, LSSP |
| Authorized Official - Phone: | 903-268-9958 |
| Mailing Address - Street 1: | 3831 BLACKJACK RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | JEFFERSON |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 75657-8296 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 903-268-9958 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 3831 BLACKJACK RD |
| Practice Address - Street 2: | |
| Practice Address - City: | JEFFERSON |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75657-8296 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 903-268-9958 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-05-07 |
| Last Update Date: | 2025-05-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | |
| No | 1041S0200X | Behavioral Health & Social Service Providers | Social Worker | School | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | ||
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | ||
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 251S00000X | Agencies | Community/Behavioral Health |
