Healthcare Provider Details

I. General information

NPI: 1871648816
Provider Name (Legal Business Name): SOUTHWEST SOCIAL SVCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14083 MAIN STREET
HOUSTON TX
77035
US

IV. Provider business mailing address

6722 ROWELL COURT
MISSOURI CITY TX
77489
US

V. Phone/Fax

Practice location:
  • Phone: 832-878-7954
  • Fax:
Mailing address:
  • Phone: 832-878-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICK CHARLES SR.
Title or Position: REV
Credential: QMHP CS REV
Phone: 832-878-2954