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NPI Code Detail

MEDICARE: MONA MENTORS COMMUNITY AGENCY

MEDICARE: MONA MENTORS COMMUNITY AGENCY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2101YM0800XMental Health Counselor
3101YP2500XProfessional Counselor
41041C0700XClinical Social Worker
5101YA0400XAddiction (Substance Use Disorder) Counselor
6101YP1600XPastoral Counselor
7172V00000XCommunity Health Worker
8251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1134543507
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONA MENTORS COMMUNITY AGENCY
Provider Business Mailing Address
First Line : 1339 MACCLESBY LN
Second Line :
City : CHANNELVIEW
State : TX
Zip : 77530-4822
Country : US
Telephone Number : 713-266-2090
Fax Number : 800-434-4305
Provider Business Practice Location Address
First Line : 507 N SAM HOUSTON PKWY E
Second Line : SUITE 125
City : HOUSTON
State : TX
Zip : 77060-4021
Country : US
Telephone Number : 713-266-2090
Fax Number : 800-434-4305
Authorized Official
Title or Position : PRESIDENT
Name : MONA SWAFFORD ELLIS
Credential : MS, CHW
Telephone Number : 713-266-2090
Provider Enumeration Date : 02/06/2014
Last Update Date : 07/07/2014

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Directions to “MONA MENTORS COMMUNITY AGENCY ” Practice Location

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