Healthcare Provider Details

I. General information

NPI: 1003491101
Provider Name (Legal Business Name): RIE KOJIMA ANGELI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 HEIGHTS BLVD
HOUSTON TX
77007-2521
US

IV. Provider business mailing address

12503 STILL HARBOUR DR
HOUSTON TX
77041-6634
US

V. Phone/Fax

Practice location:
  • Phone: 832-304-0734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: