Healthcare Provider Details

I. General information

NPI: 1780623504
Provider Name (Legal Business Name): MINA DAVE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 N W FWY
HOUSTON TX
77092-8219
US

IV. Provider business mailing address

5603 FAIRVIEW FOREST DR
HOUSTON TX
77088-1247
US

V. Phone/Fax

Practice location:
  • Phone: 713-256-1127
  • Fax: 281-261-0334
Mailing address:
  • Phone: 281-445-9802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3387
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: