1255158762 NPI number — ABA AND MENTAL HEALTH WELLNESS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255158762 NPI number — ABA AND MENTAL HEALTH WELLNESS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ABA AND MENTAL HEALTH WELLNESS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255158762
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3120 SOUTHWEST FWY
Provider Second Line Business Mailing Address:
101 PMB 945610
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-443-4686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 NORFOLK ST STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-4044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-443-4686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2024

Additional Information

Authorized Official

Authorized Official Last Name:
BOBBITT
Authorized Official First Name:
DONDRA
Authorized Official Middle Name:
LESHEA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
346-443-4686

Provider Taxonomy Codes

  • Taxonomy code: 364SP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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