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General NPI Number Information
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NPI Number | 1114567039
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Entity Type | Organization
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Legal Business Name | MINDFUL CHANGE, PLLC
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Dates
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Enumeration Date | 01/08/2020
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Last Update Date | 01/08/2020
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Provider Practice Location Address
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Address Line | 3220 SAN JACINTO ST
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City | HOUSTON
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State | TX
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Zip | 77004-2910
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Country | US
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Telephone | 281-777-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 3731 RIO VISTA ST
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City | HOUSTON
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State | TX
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Zip | 77021-1513
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Country | US
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Telephone | 832-725-5987
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Fax |
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Authorized Official
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Title or Position | LPC/OWNER
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Name | DR. LAWRENCE TAYLOR SR.
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Credential |
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Telephone | 832-725-5987
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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 |
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License Number State |
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