MEDICARE: PACEM FAMILY THERAPY, 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	106H00000X	Marriage & Family Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043964943	OTHER		PROVIDER NPI

General Provider Information

NPI Number	:	1487332680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACEM FAMILY THERAPY, LLC

Provider Business Mailing Address
First Line	:	9611 OXFORD GROVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5136
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9611 OXFORD GROVE DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-5136
Country	:	US
Telephone Number	:	281-253-8186
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA E BARBOZA
Credential	:	LMFT-S
Telephone Number	:	281-253-8186

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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