Healthcare Provider Details

I. General information

NPI: 1023811262
Provider Name (Legal Business Name): BRITTANY ANSELMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14506 CROSS JUNCTION ST
HOUSTON TX
77084-1595
US

IV. Provider business mailing address

14506 CROSS JUNCTION ST
HOUSTON TX
77084-1595
US

V. Phone/Fax

Practice location:
  • Phone: 832-273-6820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17072
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: