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General NPI Number Information
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NPI Number | 1124819321
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Entity Type | Organization
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Legal Business Name | BODY AND MIND RENEWAL HTX
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 8525 N SAM HOUSTON PKWY E STE 704
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City | HUMBLE
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State | TX
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Zip | 77396-5229
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Country | US
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Telephone | 281-436-9684
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Fax |
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Provider Business Mailing Address
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Address Line | 13134 HAWKINS BND
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City | HOUSTON
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State | TX
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Zip | 77044-1430
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Country | US
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Telephone | 210-848-4232
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Fax |
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Authorized Official
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Title or Position | PMHNP
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Name | SHATERRIA WARREN
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Credential |
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Telephone | 210-848-4232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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