1659814341 NPI number — BEACON MENTAL HEALTH & SOCIAL SERVICES, PLLC

Table of content: (NPI 1659814341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659814341 NPI number — BEACON MENTAL HEALTH & SOCIAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACON MENTAL HEALTH & SOCIAL SERVICES, 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:
1659814341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5726 SAGAMORE BAY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77469-7398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4101 GREENBRIAR ST
Provider Second Line Business Practice Location Address:
SUITE 105C
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-5294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-248-4636
Provider Business Practice Location Address Fax Number:
866-804-7241
Provider Enumeration Date:
11/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
HOUSEWORTH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
832-248-4636

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1826133-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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