Healthcare Provider Details

I. General information

NPI: 1952519332
Provider Name (Legal Business Name): CHAMPIONS CHRISTIAN COUNSELING CENTER L.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S CHERRY ST
TOMBALL TX
77375-6614
US

IV. Provider business mailing address

333 S CHERRY ST
TOMBALL TX
77375-6614
US

V. Phone/Fax

Practice location:
  • Phone: 281-357-4111
  • Fax:
Mailing address:
  • Phone: 281-357-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number59667
License Number StateTX

VIII. Authorized Official

Name: PAULA H. WHITAKER
Title or Position: MINISTRY DIRECTOR & COUNSELOR
Credential: M.ED., MA, PCC, LPCI
Phone: 281-357-4111