Healthcare Provider Details

I. General information

NPI: 1609337948
Provider Name (Legal Business Name): ASSURANCE THERAPEUTIC OUTREACH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 RAYFORD RD STE 140
SPRING TX
77386-4169
US

IV. Provider business mailing address

21602 EAST HARDY ROAD
HOUSTON TX
77073
US

V. Phone/Fax

Practice location:
  • Phone: 346-237-4282
  • Fax: 832-610-3050
Mailing address:
  • Phone: 346-237-4282
  • Fax: 832-827-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LENARD ANDERSON
Title or Position: MANAGING PARTNER
Credential:
Phone: 346-237-4282