Provider Demographics
NPI:1730949959
Name:BLACK, PRESLEY PAIGE (LPC-A)
Entity type:Individual
Prefix:
First Name:PRESLEY
Middle Name:PAIGE
Last Name:BLACK
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HIDDEN VALLEY DR APT 728
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-1539
Mailing Address - Country:US
Mailing Address - Phone:432-312-7776
Mailing Address - Fax:
Practice Address - Street 1:1101 SATELLITE VW UNIT 501
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-1591
Practice Address - Country:US
Practice Address - Phone:432-312-7776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health