Healthcare Provider Details

I. General information

NPI: 1730951187
Provider Name (Legal Business Name): FIRST BAPTIST CHURCH OF HOUSTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 LONG POINT ROAD
HOUSTON TX
77055
US

IV. Provider business mailing address

7401 KATY FREEWAY
HOUSTON TX
77024
US

V. Phone/Fax

Practice location:
  • Phone: 346-550-1055
  • Fax:
Mailing address:
  • Phone: 346-550-1055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK MAYFIELD
Title or Position: INTERMIM CLINICAL DIRECTOR
Credential:
Phone: 346-550-1055