Full Name | |
---|---|
Speciality | Counselor |
Location | 3184 Hwy 172, Ganado, Texas |
Authorized Official Name and Position | Janice M Christopher (OWNER) |
Authorized Official Contact | 3615412038 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 92 Ganado TX 77962-0092 Ph: (361) 541-2038 | 3184 Hwy 172 Ganado TX 77962-8735 Ph: (361) 541-2038 |
NPI Number | 1730658170 |
---|---|
Provider Enumeration Date | 11/15/2018 |
Last Update Date | 02/01/2024 |
Certification Date | 02/01/2024 |
Medicare PECOS PAC ID | 4587009980 |
---|---|
Medicare Enrollment ID | O20240226000833 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730658170 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
Provider Name | Janice M Christopher |
---|---|
Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1629554357 PECOS PAC ID: 5496190894 Enrollment ID: I20240226001082 |