=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356166201
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REFINED RESILIENCE COUNSELING & WELLNESS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2024
-----------------------------------------------------
Last Update Date | 12/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12926 BRIARPINE CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77041-7331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-781-4118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12926 BRIARPINE CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77041-7331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | JODECI PATRICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-781-4118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------