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General NPI Number Information
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NPI Number | 1154796266
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Entity Type | Organization
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Legal Business Name | MY OWN SPACE THERAPY
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 12/01/2015
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Provider Practice Location Address
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Address Line | 10440 DEERWOOD RD 1218
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City | HOUSTON
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State | TX
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Zip | 77042-1135
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Country | US
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Telephone | 770-756-6030
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Fax |
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Provider Business Mailing Address
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Address Line | 10440 DEERWOOD RD 1218
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City | HOUSTON
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State | TX
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Zip | 77042-1135
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Country | US
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Telephone | 770-756-6030
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. HANNAH A. D. KIMBROUGH
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Credential | LMSW
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Telephone | 770-756-6030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW005881
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License Number State | GA
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