Organization
WISE & ROOTED COUNSELING AND THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHUKIA N RELFORD MA, LCDC-I (PROGRAM ADMINISTRATOR)
(409) 273-4172
Entity
Organization
Contact information
Practice address
1050 S 11TH ST, BEAUMONT, TX 77701-4739
(409) 202-3107
Mailing address
PO BOX 2968, BEAUMONT, TX 77704-2968
(409) 877-1961
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
451638701
—
TX
Enumeration date
08/02/2022
Last updated
03/27/2023
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