Healthcare Provider Details

I. General information

NPI: 1396250528
Provider Name (Legal Business Name): DJR COMMUNITY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1937 TEXAS PKWY
MISSOURI CITY TX
77489-3121
US

IV. Provider business mailing address

1937 TEXAS PKWY
MISSOURI CITY TX
77489-3121
US

V. Phone/Fax

Practice location:
  • Phone: 832-539-1416
  • Fax: 832-539-1478
Mailing address:
  • Phone: 832-539-1416
  • Fax: 832-539-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: GLYNIS GRIFFIN
Title or Position: DIRECTOR OF CLIENT SERVICES
Credential:
Phone: 832-539-1416