Healthcare Provider Details

I. General information

NPI: 1821294646
Provider Name (Legal Business Name): TODAY'S FAMILY THERAPEUTIC SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13803 SANDOVER DR
HOUSTON TX
77014-3622
US

IV. Provider business mailing address

PO BOX Z
WOODBRIDGE VA
22194-0415
US

V. Phone/Fax

Practice location:
  • Phone: 703-915-9526
  • Fax: 800-556-0158
Mailing address:
  • Phone: 703-915-9526
  • Fax: 800-556-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number63213
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberLC1652
License Number StateMD

VIII. Authorized Official

Name: MR. LEON MICHEAL WILSON
Title or Position: PRESIDENT
Credential: LCPC
Phone: 703-915-9526