| Organization Name: | BEDROCK COUNSELING, PLLC |
| NPI Number: | 1013287721 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LILLIAM POLO (EXECUTIVE DIRECTOR) |
| Mailing Address: | 575 N Valley Parkway Suite 230 Lewisville |
| State: | TX US |
| Postal Code: | 75067 |
| Phone Number: | 9729069112 |
| Fax Number: | 9729069125 |
| NPI Enumeration Date: | 01/11/2012 |
| NPI Last Update Date: | 01/11/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |