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General NPI Number Information
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NPI Number | 1164188512
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Entity Type | Organization
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Legal Business Name | MODIFYING THOUGHTS COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 2128 ALDINE BENDER RD
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City | HOUSTON
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State | TX
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Zip | 77032-3122
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Country | US
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Telephone | 713-283-4156
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Fax |
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Provider Business Mailing Address
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Address Line | 19010 JASMINE BLOOM LN
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City | CYPRESS
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State | TX
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Zip | 77429-4208
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Country | US
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Telephone | 713-283-4156
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Fax |
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Authorized Official
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Title or Position | OWNER, CHEMICAL DEPENDENCY COUNSELO
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Name | MRS. DIEDRA SIMMONS
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Credential | LCDC
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Telephone | 713-283-4156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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License Number State |
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