Healthcare Provider Details

I. General information

NPI: 1902720063
Provider Name (Legal Business Name): ANTIDOTE FOR HOPE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15651 SCOLTY REACH LN
HUMBLE TX
77346-4919
US

IV. Provider business mailing address

15651 SCOLTY REACH LN
HUMBLE TX
77346-4919
US

V. Phone/Fax

Practice location:
  • Phone: 229-343-0627
  • Fax:
Mailing address:
  • Phone: 229-343-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA R PETTY
Title or Position: OWNER
Credential: MSN, PMHNP-BC
Phone: 229-343-0627