Healthcare Provider Details

I. General information

NPI: 1083339790
Provider Name (Legal Business Name): ECTON OAKS HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15407 PRAIRIE OAKS DR
HOUSTON TX
77083-5532
US

IV. Provider business mailing address

15407 PRAIRIE OAKS DR
HOUSTON TX
77083-5532
US

V. Phone/Fax

Practice location:
  • Phone: 713-446-9677
  • Fax:
Mailing address:
  • Phone: 713-446-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: GLORIA CRANDALL
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-639-3167