Healthcare Provider Details

I. General information

NPI: 1003664749
Provider Name (Legal Business Name): THERAPY WITH MJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 10/02/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 BUENTELLO DR
KATY TX
77449
US

IV. Provider business mailing address

3120 SOUTHWEST FWY STE 101
HOUSTON TX
77098-4520
US

V. Phone/Fax

Practice location:
  • Phone: 832-638-3363
  • Fax:
Mailing address:
  • Phone: 832-638-3363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MYEA THOMAS
Title or Position: OWNER
Credential: LPC
Phone: 713-364-5074