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General NPI Number Information
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NPI Number | 1073756417
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Entity Type | Organization
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Legal Business Name | HOUSTON ADVANCED MEDILINE CLINIC
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Dates
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Enumeration Date | 04/15/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 6550 MAPLERIDGE ST SUITE 214
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 713-669-0848
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Fax | 713-669-0648
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Provider Business Mailing Address
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Address Line | 6550 MAPLERIDGE ST SUITE 214
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 713-669-0848
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Fax | 713-669-0648
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Authorized Official
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Title or Position | CEO
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Name | MR. EMANUEL MICHAEL LORD
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Credential |
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Telephone | 713-669-0848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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