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General NPI Number Information
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NPI Number | 1124845201
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Entity Type | Organization
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Legal Business Name | ELITE CLINICAL THERAPY LLC
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Dates
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Enumeration Date | 09/20/2024
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 2450 FONDREN RD STE 306
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City | HOUSTON
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State | TX
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Zip | 77063-2318
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Country | US
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Telephone | 832-303-1116
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8591
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City | HOUSTON
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State | TX
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Zip | 77249-8591
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | JONATHON FLORES
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Credential |
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Telephone | 832-303-1116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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