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General NPI Number Information
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NPI Number | 1265304679
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Entity Type | Organization
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Legal Business Name | MACK COUNSELING RESIDENTIAL
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 7322 SOUTHWEST FWY STE 1055
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City | HOUSTON
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State | TX
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Zip | 77074-2089
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Country | US
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Telephone | 346-279-8175
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Fax |
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Provider Business Mailing Address
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Address Line | 7322 SOUTHWEST FWY STE 1055
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City | HOUSTON
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State | TX
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Zip | 77074-2089
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/ OWNER
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Name | KEVIN MACK
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Credential |
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Telephone | 346-279-8175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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