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General NPI Number Information
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NPI Number | 1396166526
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Entity Type | Organization
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Legal Business Name | LIFE SPAN MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 12/13/2013
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Last Update Date | 12/13/2013
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Provider Practice Location Address
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Address Line | 2424 W HOLCOMBE BLVD 204
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City | HOUSTON
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State | TX
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Zip | 77030-1934
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Country | US
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Telephone | 713-521-5930
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Fax | 713-521-5832
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Provider Business Mailing Address
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Address Line | 2424 W HOLCOMBE BLVD 204
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City | HOUSTON
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State | TX
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Zip | 77030-1934
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Country | US
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Telephone | 713-521-5930
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Fax | 713-521-5832
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KELLY VAN NORTON
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Credential | APN
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Telephone | 832-723-3884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 776641
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License Number State | TX
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