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General NPI Number Information
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NPI Number | 1104584564
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Entity Type | Organization
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Legal Business Name | PROSOCIAL PEERS SOCIAL SKILLS
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Dates
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Enumeration Date | 12/02/2021
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Last Update Date | 12/02/2021
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Provider Practice Location Address
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Address Line | 21623 SAN MARINO DR
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City | KATY
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State | TX
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Zip | 77450-7604
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Country | US
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Telephone | 832-790-6779
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 331
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City | PORTER
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State | TX
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Zip | 77365-0331
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Country | US
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Telephone | 832-790-6779
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CASEY REDUS
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Credential |
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Telephone | 832-790-6779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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