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General NPI Number Information
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NPI Number | 1316173826
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Entity Type | Organization
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Legal Business Name | MAE BETH'S PLACE
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 15002 MONRAD DR
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City | HOUSTON
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State | TX
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Zip | 77053-1345
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Country | US
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Telephone | 832-519-5784
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Fax |
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Provider Business Mailing Address
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Address Line | 15002 MONRAD DR
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City | HOUSTON
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State | TX
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Zip | 77053-1345
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Country | US
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Telephone | 832-519-5784
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ROSE MARIE JACKSON
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Credential | LMSW-AP
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Telephone | 832-519-5784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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 #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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