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General NPI Number Information
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NPI Number | 1255029757
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Entity Type | Organization
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Legal Business Name | HIDDEN ROOTS MENTAL HEALTH TEXAS
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 05/04/2023
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Provider Practice Location Address
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Address Line | 6601 CYPRESSWOOD DR
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City | SPRING
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State | TX
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Zip | 77379-7891
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Country | US
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Telephone | 804-629-2673
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E BROADWAY STE G
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City | HOPEWELL
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State | VA
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Zip | 23860-2809
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Country | US
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Telephone | 804-629-2673
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Fax |
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Authorized Official
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Title or Position | CEO1
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Name | JASMARY TINEO
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Credential |
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Telephone | 804-629-2673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 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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