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General NPI Number Information
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NPI Number | 1245065705
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Entity Type | Organization
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Legal Business Name | LOYALS LOGIC CENTER LLC
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Dates
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Enumeration Date | 09/04/2024
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 12703 LAUREL MEADOW WAY
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City | HOUSTON
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State | TX
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Zip | 77014-2797
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Country | US
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Telephone | 346-977-0110
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Fax | 832-327-7801
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Provider Business Mailing Address
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Address Line | 12703 LAUREL MEADOW WAY
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City | HOUSTON
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State | TX
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Zip | 77014-2797
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Country | US
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Telephone | 346-977-0110
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Fax | 832-327-7801
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Authorized Official
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Title or Position | DIRECTOR
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Name | TASHIRA JOHNSON
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Credential |
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Telephone | 346-977-0110
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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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Taxonomy #2
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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