Provider Demographics
NPI:1730619537
Name:INTREPID COUNSELING
Entity type:Organization
Organization Name:INTREPID COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCDC
Authorized Official - Phone:917-541-9112
Mailing Address - Street 1:4213 DICKASON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-3533
Mailing Address - Country:US
Mailing Address - Phone:917-541-9112
Mailing Address - Fax:
Practice Address - Street 1:3900 W 15TH ST STE 305
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4725
Practice Address - Country:US
Practice Address - Phone:917-541-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12148101YA0400X
TX54998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty