=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053605105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY ENRICHMENT CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 06/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7100 REGENCY SQUARE BLVD STE 136
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7100 REGENCY SQUARE BLVD STE 136
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3181
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | YOKO FUKUI SEUBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 65667
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------