=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376893065
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. SABRINA ECHOLS-ELLIOTT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2012
-----------------------------------------------------
Last Update Date | 09/11/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9898 BISSONNET ST SUITE 400A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-501-9296
-----------------------------------------------------
Fax | 832-767-2540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9898 BISSONNET ST SUITE 400A
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-501-9296
-----------------------------------------------------
Fax | 832-767-2540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINNESS MANANGER
-----------------------------------------------------
Name | MR. NOAH RANKIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-638-2216
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0855X
-----------------------------------------------------
Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------