Provider Demographics
NPI:1871172205
Name:PINEY WOODS COUNSELING
Entity type:Organization
Organization Name:PINEY WOODS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMOS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LSOTP
Authorized Official - Phone:903-251-2358
Mailing Address - Street 1:20491 STATE HIGHWAY 110 S
Mailing Address - Street 2:
Mailing Address - City:TROUP
Mailing Address - State:TX
Mailing Address - Zip Code:75789-5032
Mailing Address - Country:US
Mailing Address - Phone:903-576-0231
Mailing Address - Fax:
Practice Address - Street 1:1800 SHILOH RD STE 104
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-2456
Practice Address - Country:US
Practice Address - Phone:903-251-2358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty