Provider Demographics
NPI:1861963001
Name:CORONADO COUNSELING CENTER- CLEAR LAKE
Entity type:Organization
Organization Name:CORONADO COUNSELING CENTER- CLEAR LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CORONADO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, CAS, LPC-S
Authorized Official - Phone:281-512-1976
Mailing Address - Street 1:1115 GEMINI ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2707
Mailing Address - Country:US
Mailing Address - Phone:281-461-6220
Mailing Address - Fax:833-593-9064
Practice Address - Street 1:1115 GEMINI ST STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2707
Practice Address - Country:US
Practice Address - Phone:281-461-6220
Practice Address - Fax:833-593-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1447654595OtherNPI