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General NPI Number Information
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NPI Number | 1215329941
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Entity Type | Organization
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Legal Business Name | MODERN THERAPY, PLLC
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 900 LOVETT BLVD
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City | HOUSTON
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State | TX
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Zip | 77006-3908
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Country | US
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Telephone | 281-783-9297
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30244
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City | HOUSTON
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State | TX
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Zip | 77249-0244
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Country | US
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Telephone | 281-783-9297
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BEATRIZ CRAVEN
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Credential |
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Telephone | 281-783-9297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 36766
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License Number State | TX
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