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General NPI Number Information
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NPI Number | 1225208226
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Entity Type | Individual
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Provider Name | PROVILLA HENDERSON SCRUGGS M.ED.
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Gender | Female
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 12/10/2019
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Provider Practice Location Address
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Address Line | 8303 SOUTHWEST FWY 640
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City | HOUSTON
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State | TX
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Zip | 77074-1600
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Country | US
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Telephone | 832-816-8984
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Fax | 832-816-8984
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Provider Business Mailing Address
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Address Line | 13010 FLAXSEED WAY
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City | STAFFORD
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State | TX
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Zip | 77477-3408
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Country | US
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Telephone | 281-564-4348
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Fax | 281-564-4786
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 723
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1929
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License Number State | TX
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