Healthcare Provider Details

I. General information

NPI: 1407637960
Provider Name (Legal Business Name): EMMANUEL EBEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 E GRIFFIN PKWY STE G
MISSION TX
78572-3309
US

IV. Provider business mailing address

2708 E GRIFFIN PKWY STE G
MISSION TX
78572-3309
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-6393
  • Fax:
Mailing address:
  • Phone: 956-682-6393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EMMANUEL EBEN
Title or Position: CEO
Credential:
Phone: 408-460-7444