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General NPI Number Information
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NPI Number | 1063323368
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Entity Type | Organization
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Legal Business Name | INNERBALANCE DIAGNOSIS CENTER TX
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 2603 AUGUSTA DR UNIT 102
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City | HOUSTON
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State | TX
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Zip | 77057-5678
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Country | US
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Telephone | 346-586-5732
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Fax | 919-935-0858
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Provider Business Mailing Address
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Address Line | 501 W WILLIAMS ST UNIT 1036
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City | APEX
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State | NC
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Zip | 27502-2297
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Country | US
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Telephone | 346-586-5732
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Fax | 919-935-0858
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHIRLEYJO LEE
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Credential |
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Telephone | 984-319-7357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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