Healthcare Provider Details

I. General information

NPI: 1174063994
Provider Name (Legal Business Name): REGENERATION BEHAVORIAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6699 CHIMNEY ROCK RD SUITE 201A
HOUSTON TX
77081
US

IV. Provider business mailing address

6699 CHIMNEY ROCK RD SUITE 201A
HOUSTON TX
77081
US

V. Phone/Fax

Practice location:
  • Phone: 832-530-4352
  • Fax:
Mailing address:
  • Phone: 832-530-4352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. GEORGE ROSE III
Title or Position: MANAGING MEMBER
Credential:
Phone: 832-530-4352