Basic Information
| Provider Information | |||||||||
| NPI: | 1922057769 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAFT COUNSELING CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4722 TAFT BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763084800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406911899 | ||||||||
| FaxNumber: | 9406913423 | ||||||||
| Practice Location | |||||||||
| Address1: | 4722 TAFT BLVD | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763084800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9406911899 | ||||||||
| FaxNumber: | 9406913423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 07/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | KJAER | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9406911899 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 19099 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103TB0200X | 31569 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 106H00000X | 002381 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 003347 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 004954 | TX | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YP2500X | 19361 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | OOU97X | 01 | TX | BLUE CROSS | OTHER | 079830801 | 05 | TX | MEDICAID |