Healthcare Provider Details

I. General information

NPI: 1609093707
Provider Name (Legal Business Name): CPRC HOLDING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25134 OAKHURST DR
SPRING TX
77386-1421
US

IV. Provider business mailing address

25134 OAKHURST DR
SPRING TX
77386-1421
US

V. Phone/Fax

Practice location:
  • Phone: 281-630-3721
  • Fax:
Mailing address:
  • Phone: 281-630-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number60602
License Number StateTX

VIII. Authorized Official

Name: GLENN BRICKEN
Title or Position: CLINICAL DIRECTOR
Credential: PSYD
Phone: 281-364-0067