Healthcare Provider Details

I. General information

NPI: 1669287256
Provider Name (Legal Business Name): ROSSANA D ESCALONA FARIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 S LOOP W STE 430
HOUSTON TX
77054-5623
US

IV. Provider business mailing address

1226 LARKS TRACE LN
HOUSTON TX
77090-7504
US

V. Phone/Fax

Practice location:
  • Phone: 832-431-4246
  • Fax:
Mailing address:
  • Phone: 713-309-0309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97885
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: