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General NPI Number Information
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NPI Number | 1134543507
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Entity Type | Organization
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Legal Business Name | MONA MENTORS COMMUNITY AGENCY
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Dates
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Enumeration Date | 02/06/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 507 N SAM HOUSTON PKWY E SUITE 125
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City | HOUSTON
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State | TX
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Zip | 77060-4021
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Country | US
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Telephone | 713-266-2090
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Fax | 800-434-4305
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Provider Business Mailing Address
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Address Line | 1339 MACCLESBY LN
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City | CHANNELVIEW
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State | TX
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Zip | 77530-4822
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Country | US
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Telephone | 713-266-2090
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Fax | 800-434-4305
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Authorized Official
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Title or Position | PRESIDENT
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Name | MONA SWAFFORD ELLIS
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Credential | MS, CHW
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Telephone | 713-266-2090
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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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Taxonomy #2
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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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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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Taxonomy #6
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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Taxonomy #7
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #8
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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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