| Pediatric And Family Counseling Of Texarkana | |
|
1848 Lone Star Rd Ste 125 Mansfield TX 76063-5791 | |
| (682) 422-7070 | |
| Not Available |
| Full Name | Pediatric And Family Counseling Of Texarkana |
|---|---|
| Speciality | Counselor |
| Location | 1848 Lone Star Rd Ste 125, Mansfield, Texas |
| Authorized Official Name and Position | Elisha Lambert (OWNER) |
| Authorized Official Contact | 6824227070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric And Family Counseling Of Texarkana 1848 Lone Star Rd Ste 125 Mansfield TX 76063-5791 Ph: (682) 422-7070 | Pediatric And Family Counseling Of Texarkana 1848 Lone Star Rd Ste 125 Mansfield TX 76063-5791 Ph: (682) 422-7070 |
| NPI Number | 1992207054 |
|---|---|
| Provider Enumeration Date | 03/05/2018 |
| Last Update Date | 02/06/2024 |
| Certification Date | 02/06/2024 |
| Medicare PECOS PAC ID | 0143674531 |
|---|---|
| Medicare Enrollment ID | O20240213000131 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992207054 | NPI | - | NPPES |
| 345128803 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 73578 (Texas) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Elisha Lambert |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699809764 PECOS PAC ID: 1052765443 Enrollment ID: I20240212004164 |
| Provider Name | Timothy D Stanley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538113402 PECOS PAC ID: 2769788975 Enrollment ID: I20240326000711 |
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