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General NPI Number Information
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NPI Number | 1073931226
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Entity Type | Organization
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Legal Business Name | TEEN HEALTH CENTER, INC.
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 4115 AVENUE O ROOM 1003-B
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City | GALVESTON
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State | TX
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Zip | 77550-6940
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Country | US
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Telephone | 409-766-5791
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Fax | 409-765-5026
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Provider Business Mailing Address
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Address Line | PO BOX 925
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City | GALVESTON
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State | TX
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Zip | 77553-0925
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Country | US
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Telephone | 409-766-5791
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Fax | 409-765-5026
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | HAPPY SPILLAR
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Credential | MSW
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Telephone | 409-766-5791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 539821
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License Number State | TX
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