Organization
ST JOSEPH COUNSELING & REHABILITATION SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN A CHINWEZE (ADMINISTRATOR)
(903) 581-7973
Entity
Organization
Contact information
Practice address
3334 S SW LOOP 323, SUITE 108, TYLER, TX 75701-9237
(903) 581-7973
(903) 581-6605
Mailing address
3334 S SW LOOP 323, SUITE 108, TYLER, TX 75701-9237
(903) 581-7973
(903) 581-6605
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
103TR0400X
Rehabilitation Psychologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194941518
—
LA
Enumeration date
03/05/2012
Last updated
04/16/2012
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