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General NPI Number Information
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NPI Number | 1154578292
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Entity Type | Organization
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Legal Business Name | PROGRAM FOR SIDE EFFECTS MANAGEMENT
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Dates
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Enumeration Date | 08/20/2008
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Last Update Date | 08/22/2008
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Provider Practice Location Address
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Address Line | 3224 YOAKUM BLVD
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City | HOUSTON
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State | TX
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Zip | 77006-3926
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Country | US
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Telephone | 713-520-5288
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Fax | 713-521-7419
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Provider Business Mailing Address
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Address Line | 3224 YOAKUM BLVD
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City | HOUSTON
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State | TX
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Zip | 77006-3926
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Country | US
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Telephone | 713-520-5288
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Fax | 713-521-7419
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. FRED WALTERS JR.
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Credential |
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Telephone | 713-520-5288
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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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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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