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General NPI Number Information
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NPI Number | 1427666353
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Entity Type | Organization
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Legal Business Name | FRESH START PSYCHIATRIC CLINIC
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Dates
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Enumeration Date | 07/16/2020
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Last Update Date | 07/16/2021
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Provider Practice Location Address
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Address Line | 11455 FALLBROOK DR STE 201
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City | HOUSTON
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State | TX
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Zip | 77065-4267
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Country | US
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Telephone | 337-223-9487
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Fax | 888-511-5650
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Provider Business Mailing Address
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Address Line | 1921 DULLES DR
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City | LAFAYETTE
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State | LA
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Zip | 70506-2716
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Country | US
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Telephone | 373-223-9487
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Fax | 888-511-5650
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Authorized Official
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Title or Position | OWNER
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Name | MATTHIAUS SUIRE
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Credential | CNS
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Telephone | 512-952-0295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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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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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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