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General NPI Number Information
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NPI Number | 1154780211
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Entity Type | Organization
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Legal Business Name | MIGHTY YOUNG MEN
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Dates
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Enumeration Date | 02/17/2016
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Last Update Date | 02/17/2016
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Provider Practice Location Address
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Address Line | 27102 BRETON BRIDGE CT
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City | CYPRESS
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State | TX
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Zip | 77433-7552
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Country | US
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Telephone | 346-401-1019
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Fax |
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Provider Business Mailing Address
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Address Line | 27102 BRETON BRIDGE CT
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City | CYPRESS
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State | TX
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Zip | 77433-7552
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Country | US
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Telephone | 346-401-1019
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | MR. KENYATTA BROWN
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Credential |
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Telephone | 346-401-1019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number | 00000000
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License Number State | TX
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