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General NPI Number Information
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NPI Number | 1144548140
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Entity Type | Organization
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Legal Business Name | CLEAR LAKE HEALTHCARE
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Dates
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Enumeration Date | 05/14/2010
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Last Update Date | 05/14/2010
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Provider Practice Location Address
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Address Line | 9 PROFESSIONAL PARK DR. SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-332-4555
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Fax | 281-332-8439
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Provider Business Mailing Address
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Address Line | 9 PROFESSIONAL PARK DR. SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-332-4555
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Fax | 281-332-8439
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MS. JAMIE LEE BECK
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Credential | OWNER
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Telephone | 281-332-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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