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General NPI Number Information
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NPI Number | 1053878355
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Entity Type | Organization
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Legal Business Name | MAINSTAY YOUTH SERVICES LLC
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Dates
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Enumeration Date | 02/23/2019
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Last Update Date | 02/23/2019
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Provider Practice Location Address
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Address Line | 7919 WEST RD
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City | HOUSTON
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State | TX
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Zip | 77064-8042
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Country | US
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Telephone | 713-965-3801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3134
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City | PEARLAND
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State | TX
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Zip | 77588-3134
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Country | US
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Telephone | 713-965-3801
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | BRIAN CHARLES SCHULZ
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Credential | MSED,LPHA, LPC, LCDC
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Telephone | 713-965-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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