=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063166452
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPY CENTER OF HOUSTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2022
-----------------------------------------------------
Last Update Date | 02/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 MONTROSE BLVD STE 520
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-628-6744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4200 MONTROSE BLVD STE 520
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77006-5445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-628-6744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE OWNER
-----------------------------------------------------
Name | SHARON GREEN MCLENDON
-----------------------------------------------------
Credential | MED
-----------------------------------------------------
Telephone | 713-628-6744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------