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General NPI Number Information
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NPI Number | 1285269050
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Entity Type | Organization
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Legal Business Name | THE EKKLESIA CONCIERGE TELEPSYCHIATRY & MENTAL HEALTH SERVICES PLLC.
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Dates
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Enumeration Date | 03/11/2020
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Last Update Date | 03/11/2020
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Provider Practice Location Address
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Address Line | 6550 MAPLERIDGE ST
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City | HOUSTON
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State | TX
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Zip | 77081-4600
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Country | US
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Telephone | 832-778-8887
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Fax |
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Provider Business Mailing Address
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Address Line | 13410 EXPLORER DR
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City | HOUSTON
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State | TX
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Zip | 77044-1089
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Country | US
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Telephone | 832-778-8887
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCH NP
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Name | ANNIE LAW
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Credential | MSN, APRN, PMHNP-BC
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Telephone | 832-778-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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