Provider Demographics
NPI:1447881230
Name:ROLLING PLAINS COUNSELING & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:ROLLING PLAINS COUNSELING & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:SOUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-930-9130
Mailing Address - Street 1:1510 15TH STREET
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:79095
Mailing Address - Country:US
Mailing Address - Phone:806-447-0147
Mailing Address - Fax:866-832-2587
Practice Address - Street 1:1510 15TH STREET
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:TX
Practice Address - Zip Code:79095
Practice Address - Country:US
Practice Address - Phone:806-447-0147
Practice Address - Fax:866-832-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX331728102Medicaid