Healthcare Provider Details

I. General information

NPI: 1740302512
Provider Name (Legal Business Name): EAGLE PAIN & STRESS CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 NASSAU DR
SUGAR LAND TX
77479-2115
US

IV. Provider business mailing address

4542 NASSAU DR
SUGAR LAND TX
77479-2115
US

V. Phone/Fax

Practice location:
  • Phone: 832-794-1621
  • Fax: 281-565-1853
Mailing address:
  • Phone: 832-794-1621
  • Fax: 281-565-1853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6082
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1841
License Number StateTX

VIII. Authorized Official

Name: MS. CARLA L HARDY
Title or Position: PRESIDENT
Credential: LMFT, LPC
Phone: 832-794-1621