Provider Demographics
NPI:1366132664
Name:CENTER FOR COUNSELING AND WELLBEING OF NORTHEAST TEXAS PLLC
Entity type:Organization
Organization Name:CENTER FOR COUNSELING AND WELLBEING OF NORTHEAST TEXAS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PATRAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:903-375-0048
Mailing Address - Street 1:PO BOX 1316
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75429-1316
Mailing Address - Country:US
Mailing Address - Phone:903-375-0048
Mailing Address - Fax:903-246-3126
Practice Address - Street 1:101 KING PLZ STE D
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3734
Practice Address - Country:US
Practice Address - Phone:903-375-0048
Practice Address - Fax:903-246-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty