| Protostar Journey Pllc | |
|
1214 Ellis Ave Lufkin TX 75904-3326 | |
| (936) 937-0074 | |
| (936) 637-0081 |
| Full Name | Protostar Journey Pllc |
|---|---|
| Speciality | Counselor |
| Location | 1214 Ellis Ave, Lufkin, Texas |
| Authorized Official Name and Position | Marguerite Braden (COUNSELOR/OWNER) |
| Authorized Official Contact | 9369370074 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Protostar Journey Pllc 1214 Ellis Ave Lufkin TX 75904-3326 Ph: (936) 937-0074 | Protostar Journey Pllc 1214 Ellis Ave Lufkin TX 75904-3326 Ph: (936) 937-0074 |
| NPI Number | 1679272116 |
|---|---|
| Provider Enumeration Date | 02/23/2023 |
| Last Update Date | 11/05/2024 |
| Certification Date | 11/05/2024 |
| Medicare PECOS PAC ID | 7315480431 |
|---|---|
| Medicare Enrollment ID | O20240618000911 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679272116 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Marguerite A Braden |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1851781264 PECOS PAC ID: 9234576851 Enrollment ID: I20240319001380 |
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