Healthcare Provider Details

I. General information

NPI: 1023760865
Provider Name (Legal Business Name): POUR INTO YOU MENTAL HEALTH & WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22203 IMPERIOUS PKWY
HOUSTON TX
77073-1389
US

IV. Provider business mailing address

22203 IMPERIOUS PKWY
HOUSTON TX
77073-1389
US

V. Phone/Fax

Practice location:
  • Phone: 510-692-0990
  • Fax:
Mailing address:
  • Phone: 510-692-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENISHA CAPRON
Title or Position: CEO
Credential: LPC, LMFT
Phone: 510-692-0990