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General NPI Number Information
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NPI Number | 1437815800
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Entity Type | Organization
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Legal Business Name | OPEN HEART, OPEN MIND
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Dates
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Enumeration Date | 11/10/2021
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 15200 MEMORIAL DR UNIT 3111
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City | HOUSTON
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State | TX
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Zip | 77079-2657
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Country | US
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Telephone | 502-851-6485
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 941684
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City | HOUSTON
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State | TX
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Zip | 77094-8684
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Country | US
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Telephone | 430-558-1685
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | SHANNA M DAVIDSON
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Credential | LCSW
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Telephone | 430-558-1685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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