Healthcare Provider Details

I. General information

NPI: 1144471343
Provider Name (Legal Business Name): AWARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12102 BISSONNET ST
HOUSTON TX
77099-1414
US

IV. Provider business mailing address

2211 NORFOLK ST SUITE 505
HOUSTON TX
77098-4096
US

V. Phone/Fax

Practice location:
  • Phone: 281-933-2400
  • Fax: 713-528-5717
Mailing address:
  • Phone: 713-268-4452
  • Fax: 713-528-5717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number883776
License Number StateTX

VIII. Authorized Official

Name: DR. JESSE A. REED III
Title or Position: CEO
Credential: PH.D.
Phone: 713-268-4452