My Own Counselor

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

68526 Issued in TX

Legal business name

MY OWN COUNSELOR

Practice address

1101 Ridge Rd
102
Rockwall, TX 75087-4250

Phone

(469) 877-6190

NPI assigned

Jun 11, 2013

Last updated

Jun 11, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Connie Pettitt, LPC

Title

Manager

Phone

(469) 877-6190

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1659719615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 RIDGE RD",
            "address_2": "102",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750874250",
            "telephone_number": "469-877-6190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 RIDGE RD",
            "address_2": "102",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750874250",
            "telephone_number": "469-877-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY OWN COUNSELOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "PETTITT",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "469-877-6190",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "68526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Rockwall, TX
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• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.