1659633121 NPI number — KURT DAVIS ATTAWAY M.A., LMFTA

Table of content: KURT DAVIS ATTAWAY M.A., LMFTA (NPI 1659633121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659633121 NPI number — KURT DAVIS ATTAWAY M.A., LMFTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTAWAY
Provider First Name:
KURT
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFTA
Provider Gender Code:
M

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:
1659633121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 S SHORE BLVD
Provider Second Line Business Mailing Address:
#300
Provider Business Mailing Address City Name:
LEAGUE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77573-2943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-736-7072
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 BROADWAY ST
Provider Second Line Business Practice Location Address:
SUITE 2743
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-9785
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-736-7072
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  201874 , 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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