| Main Street Counseling Center, Llc | |
|
621 N Main St Suite 200 Grapevine TX 76051-9213 | |
| (817) 886-5777 | |
| (817) 421-1950 |
| Full Name | Main Street Counseling Center, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 621 N Main St, Grapevine, Texas |
| Authorized Official Name and Position | Sheri Lee Golly (OWNER) |
| Authorized Official Contact | 8178865777 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Counseling Center, Llc 621 N Main St Suite 200 Grapevine TX 76051-9213 Ph: (817) 886-5777 | Main Street Counseling Center, Llc 621 N Main St Suite 200 Grapevine TX 76051-9213 Ph: (817) 886-5777 |
| NPI Number | 1609193002 |
|---|---|
| Provider Enumeration Date | 04/23/2010 |
| Last Update Date | 04/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609193002 | NPI | - | NPPES |
| 063955102 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 16044 (Texas) | Primary |
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