Basic Information
| Provider Information | |||||||||
| NPI: | 1396902524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INSIDE-OUT COUNSELING & CONSULTATION SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 173684 | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760033684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172336939 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2912 LITTLE RD | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760161725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172336939 | ||||||||
| FaxNumber: | 8173617521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2008 | ||||||||
| LastUpdateDate: | 05/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | RHODES | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8172336939 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | L.P.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 17947 | TX | Y | Agencies | Community/Behavioral Health |
No ID Information.