Provider Demographics
NPI:1548333248
Name:SOLUTIONS SUPPORT CENTER FOR COUNSELING, PLLC
Entity type:Organization
Organization Name:SOLUTIONS SUPPORT CENTER FOR COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KEAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, ATR, BC
Authorized Official - Phone:806-376-4030
Mailing Address - Street 1:PO BOX 3066
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3066
Mailing Address - Country:US
Mailing Address - Phone:806-376-4030
Mailing Address - Fax:806-376-4424
Practice Address - Street 1:1721 S TYLER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-3141
Practice Address - Country:US
Practice Address - Phone:806-376-4030
Practice Address - Fax:806-376-4424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00000022CKOtherBLUE CROSS BLUE SHIELD