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General NPI Number Information
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NPI Number | 1174092977
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Entity Type | Organization
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Legal Business Name | NICHE MEDICAL ACADEMY INC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 11/21/2018
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Provider Practice Location Address
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Address Line | 7066 LAKEVIEW HAVEN DR STE 125B
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City | HOUSTON
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State | TX
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Zip | 77095-2560
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Country | US
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Telephone | 281-300-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 7066 LAKEVIEW HAVEN DR STE 125B
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City | HOUSTON
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State | TX
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Zip | 77095-2560
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Country | US
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Telephone | 281-300-4250
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. EUSEBIUS UCHE OJONTA
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Credential |
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Telephone | 281-339-4250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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