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Organization

FAMILY ADVOCACY CENTER

Active
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Organization

FAMILY ADVOCACY CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. SANDRA KELLEY SHOULDERS L.P.C. (GENERAL PARTNER)
(903) 276-9242
Entity
Organization

Contact information

Practice address
1180 OLD REDWATER RD, TEXARKANA, TX 75501-2253
(903) 276-9242
Mailing address
1180 OLD REDWATER ROAD, TEXARKANA, TX 75501-2253
(903) 276-9242

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
64428
TX
251S00000X
Community/Behavioral Health Agency
4844
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4844
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX
01
64428
TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS
TX
Enumeration date
12/28/2010
Last updated
02/04/2011
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