MEDICARE: POUR COLLABORATIVE

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1356033120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POUR COLLABORATIVE

Provider Business Mailing Address
First Line	:	340 N SAM HOUSTON PKWY E STE 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3321
Country	:	US
Telephone Number	:	832-781-8715
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 N SAM HOUSTON PKWY E STE 249
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-3321
Country	:	US
Telephone Number	:	832-781-8715
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	CATINA ERWIN
Credential	:	LPC
Telephone Number	:	832-781-8715

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/22/2023

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Directions to “POUR COLLABORATIVE ” Practice Location

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