Healthcare Provider Details

I. General information

NPI: 1285960971
Provider Name (Legal Business Name): MINT HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9898 BISSONNET ST 410
HOUSTON TX
77036-8270
US

IV. Provider business mailing address

9898 BISSONNET ST 410
HOUSTON TX
77036-8270
US

V. Phone/Fax

Practice location:
  • Phone: 832-203-5805
  • Fax:
Mailing address:
  • Phone: 832-203-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: LESHONDA ROYALE QUINNY
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 832-203-5805