Healthcare Provider Details

I. General information

NPI: 1962899716
Provider Name (Legal Business Name): REFUGE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 NORTH FRAZIER STREET
CONROE TX
77303
US

IV. Provider business mailing address

3513 NORTH FRAZIER STREET
CONROE TX
77303
US

V. Phone/Fax

Practice location:
  • Phone: 936-648-5379
  • Fax: 866-341-0586
Mailing address:
  • Phone: 936-648-5379
  • Fax: 866-341-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67759
License Number StateTX

VIII. Authorized Official

Name: SHANNON BROWN
Title or Position: CLINICAL DIRECTOR/OWNER
Credential: LPC
Phone: 936-648-5379