Healthcare Provider Details

I. General information

NPI: 1679762157
Provider Name (Legal Business Name): HOUSTON MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 N HOUSTON RD SUITE 140 G
WARNER ROBINS GA
31093-3074
US

IV. Provider business mailing address

233 N HOUSTON RD SUITE 140 G
WARNER ROBINS GA
31093-3074
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-3366
  • Fax:
Mailing address:
  • Phone: 478-923-3366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number051476
License Number StateGA

VIII. Authorized Official

Name: DAN IOANITESCU
Title or Position: OWNER
Credential: MD
Phone: 478-923-3366