1215167192 NPI number — MEADOWS COUNSELING CENTER

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 1215167192 NPI number — MEADOWS COUNSELING CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEADOWS COUNSELING CENTER
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:
1215167192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1502
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PORTE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77572-1502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-794-0646
Provider Business Mailing Address Fax Number:
281-867-0194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4650 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77536-6353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
823-794-0646
Provider Business Practice Location Address Fax Number:
281-867-0194
Provider Enumeration Date:
07/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLASS MEADOWS
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
VIANNA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-794-0646

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  61821 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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