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1808 South St Nacogdoches TX 75964-6120 | |
| (936) 615-1122 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 1808 South St, Nacogdoches, Texas |
| Authorized Official Name and Position | Ginger Stephens (OWNER) |
| Authorized Official Contact | 9363053070 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1808 South St Nacogdoches TX 75964-6120 Ph: (936) 615-1122 | 1808 South St Nacogdoches TX 75964-6120 Ph: (936) 615-1122 |
| NPI Number | 1114543634 |
|---|---|
| Provider Enumeration Date | 06/20/2020 |
| Last Update Date | 10/23/2020 |
| Certification Date | 10/23/2020 |
| Medicare PECOS PAC ID | 2264886951 |
|---|---|
| Medicare Enrollment ID | O20240311001480 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114543634 | NPI | - | NPPES |
| 1720523657 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Ginger Frances Stephens |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1720523657 PECOS PAC ID: 9830535038 Enrollment ID: I20240815001597 |
| Provider Name | Emily Morris Taravella |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1679097455 PECOS PAC ID: 8426581406 Enrollment ID: I20241029003717 |
| Provider Name | Katelynne Flowers |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073196614 PECOS PAC ID: 3173057270 Enrollment ID: I20241112003580 |
| Provider Name | Amanda Ann Turner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1578161626 PECOS PAC ID: 8527593938 Enrollment ID: I20241121004357 |
| Provider Name | Catharine Munguia |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689386963 PECOS PAC ID: 3274069299 Enrollment ID: I20241212004266 |
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