Provider Demographics
NPI:1861902678
Name:EXCELSIOR SERVICES AND CONSULTING, LLC
Entity type:Organization
Organization Name:EXCELSIOR SERVICES AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:MR
Authorized Official - First Name:NEALY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:682-247-7979
Mailing Address - Street 1:4929 OASIS CT APT 2001
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-8745
Mailing Address - Country:US
Mailing Address - Phone:682-247-7979
Mailing Address - Fax:
Practice Address - Street 1:4929 OASIS CT APT 2001
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-8745
Practice Address - Country:US
Practice Address - Phone:682-247-7979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty