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General NPI Number Information
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NPI Number | 1013353341
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Entity Type | Organization
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Legal Business Name | GREATER HOUSTON COUNSELING AND THERAPY CENTER
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Dates
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Enumeration Date | 05/14/2013
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 5132 MIMOSA DR
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City | BELLAIRE
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State | TX
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Zip | 77401-4941
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Country | US
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Telephone | 646-957-3581
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Fax | 713-838-9943
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Provider Business Mailing Address
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Address Line | 5132 MIMOSA DR
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City | BELLAIRE
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State | TX
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Zip | 77401-4941
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Country | US
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Telephone | 646-957-3581
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Fax | 713-838-9943
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Authorized Official
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Title or Position | THERAPIST
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Name | RICHARD WAGNER
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Credential | M.A., ED.M., L.P.C.
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Telephone | 646-957-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 69088
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License Number State | TX
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