Healthcare Provider Details

I. General information

NPI: 1912689654
Provider Name (Legal Business Name): CENTERPOINT WELLNESS SERVICES OF TEXAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 S COLUMBIA AVE STE 215
TULSA OK
74114-3507
US

IV. Provider business mailing address

23144 CINCO RANCH BLVD SUITE B PMB 1147
KATY TX
77494
US

V. Phone/Fax

Practice location:
  • Phone: 832-510-6605
  • Fax: 844-273-7546
Mailing address:
  • Phone: 832-510-6605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAQUEL COLBERT-DAWSON
Title or Position: OWNER
Credential: LPC
Phone: 918-378-9039