Legal Business Name

NPI #1669200804 in Joshua, Texas

Provider Information

NPI Number
1669200804
Entity Type
Organization
Organization Name
Legal Business Name
Primary Specialty
Counselor - Professional
Enumeration Date
Jul 22, 2024
Last Updated
Jul 22, 2024

Practice Location

Address
120 INDEPENDENCE DR
City
Joshua
State
Texas
ZIP Code
76058-4645
Phone
(903) 237-9689

Authorized Official

Name
MR. NICHOLAS JAY SIMMONS, MA, LPCA
Title
COUNSELOR
Phone
(903) 237-9689

Specialties & Taxonomy Codes

Specialty
Counselor - ProfessionalProfessional

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