Healthcare Provider Details

I. General information

NPI: 1093332801
Provider Name (Legal Business Name): HOPE SEED SUPPORT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 EARLINGTON MANOR DR
SPRING TX
77379-7459
US

IV. Provider business mailing address

10103 EARLINGTON MANOR DR
SPRING TX
77379-7459
US

V. Phone/Fax

Practice location:
  • Phone: 281-883-8048
  • Fax: 949-655-7811
Mailing address:
  • Phone: 281-883-8048
  • Fax: 949-655-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: MRS. AIMEE MEDINA
Title or Position: EXECUTIVE DIRECTOR
Credential: BBS
Phone: 281-883-8048