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General NPI Number Information
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NPI Number | 1053038273
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Entity Type | Organization
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Legal Business Name | ELEMENTAL FAMILY SERVICES
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 07/18/2023
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Provider Practice Location Address
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Address Line | 2200 SPACE PARK DR STE 240
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City | HOUSTON
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State | TX
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Zip | 77058-3677
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Country | US
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Telephone | 346-857-5319
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Fax |
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Provider Business Mailing Address
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Address Line | 621 POWER ST
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City | LEAGUE CITY
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State | TX
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Zip | 77573-5539
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Country | US
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Telephone | 346-857-5319
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | COREY KAUFFMAN
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Credential |
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Telephone | 346-857-5319
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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