MEDICARE: HOUSTON INTIMACY AND ATTACHMENT INSTITUTE

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1871006643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON INTIMACY AND ATTACHMENT INSTITUTE

Provider Business Mailing Address
First Line	:	16310 LUZERNE DR UNIT C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1726
Country	:	US
Telephone Number	:	281-704-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	16310 LUZERNE DR UNIT C
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-1726
Country	:	US
Telephone Number	:	281-704-2252
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR & THERAPIST
Name	:	SHENA TUBBS
Credential	:
Telephone Number	:	281-704-2252

Provider Enumeration Date	:	11/14/2017
Last Update Date	:	11/14/2017

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