MEDICARE: COALESCE HEALTH SERVICES, LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1295010130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COALESCE HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	8411 W BELLFORT ST
Second Line	:	SUITE 110B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2205
Country	:	US
Telephone Number	:	713-534-1371
Fax Number	:	832-767-3762

Provider Business Practice Location Address
First Line	:	8411 W BELLFORT ST
Second Line	:	SUITE 110B
City	:	HOUSTON
State	:	TX
Zip	:	77071-2205
Country	:	US
Telephone Number	:	713-534-1371
Fax Number	:	832-767-3762

Authorized Official
Title or Position	:	CEO
Name	:	MRS. GLORIA J. FRANCIS
Credential	:
Telephone Number	:	713-534-1371

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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