Healthcare Provider Details

I. General information

NPI: 1780372995
Provider Name (Legal Business Name): AWARE THERAPEUTIC SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 PRAIRIE TERRACE LN
FULSHEAR TX
77441-2199
US

IV. Provider business mailing address

1321 UPLAND DRIVE PMB 5087
HOUSTON TX
77043
US

V. Phone/Fax

Practice location:
  • Phone: 832-780-3035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DESIREE SHANKLE
Title or Position: OWNER
Credential:
Phone: 832-780-3035