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General NPI Number Information
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NPI Number | 1235902529
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Entity Type | Organization
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Legal Business Name | SALTY SUNSHINE
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 10/30/2023
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Provider Practice Location Address
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Address Line | 4306 YOAKUM BLVD STE 510
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City | HOUSTON
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State | TX
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Zip | 77006-5884
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Country | US
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Telephone | 346-437-0777
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Fax |
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Provider Business Mailing Address
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Address Line | 11311 ATWELL DR
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City | HOUSTON
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State | TX
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Zip | 77035-2615
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Country | US
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Telephone | 806-584-7916
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JULIET-DANIELLE LANE
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Credential | LCSW
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Telephone | 806-584-7916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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