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General NPI Number Information
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NPI Number | 1063713956
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Entity Type | Organization
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Legal Business Name | DIFFERENT DIRECTION LLC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 1211 WESLEY DR
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City | STAFFORD
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State | TX
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Zip | 77477-6493
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Country | US
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Telephone | 832-640-1062
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 262
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City | MISSOURI CITY
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State | TX
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Zip | 77459-0262
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. KAREN AMBER WEBB
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Credential | LPC
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Telephone | 832-640-1062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 61470
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License Number State | TX
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