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General NPI Number Information
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NPI Number | 1073857512
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Entity Type | Organization
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Legal Business Name | SECOND CHANCE BEHAVIOR
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 14030 WHISPERING PALMS DR
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City | HOUSTON
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State | TX
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Zip | 77066-5526
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Country | US
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Telephone | 832-516-4003
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Fax |
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Provider Business Mailing Address
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Address Line | 14030 WHISPERING PALMS DR
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City | HOUSTON
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State | TX
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Zip | 77066-5526
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Country | US
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Telephone | 832-516-4003
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ANNETTE JONES
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Credential |
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Telephone | 832-519-4003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67001
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License Number State | TX
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