Provider Demographics
NPI:1134235963
Name:NORTHWEST COUNSELING & WELLNESS CENTER
Entity type:Organization
Organization Name:NORTHWEST COUNSELING & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:512-250-9355
Mailing Address - Street 1:12335 HYMEADOW DR
Mailing Address - Street 2:#300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1934
Mailing Address - Country:US
Mailing Address - Phone:512-250-9355
Mailing Address - Fax:512-250-0229
Practice Address - Street 1:12335 HYMEADOW DR
Practice Address - Street 2:#300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1934
Practice Address - Country:US
Practice Address - Phone:512-250-9355
Practice Address - Fax:512-250-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13038101YA0400X
TX4933101YM0800X
TX3092-3302324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty