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General NPI Number Information
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NPI Number | 1477932119
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Entity Type | Organization
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Legal Business Name | ABUNDANT LIFE THERAPEUTIC SERVICES TEXAS
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 06/22/2019
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Provider Practice Location Address
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Address Line | 260 N SAM HOUSTON PKWY E STE 350
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City | HOUSTON
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State | TX
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Zip | 77060-2024
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Country | US
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Telephone | 832-300-8680
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Fax | 832-300-8685
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Provider Business Mailing Address
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Address Line | 260 N SAM HOUSTON PKWY E STE 350
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City | HOUSTON
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State | TX
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Zip | 77060-2024
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Country | US
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Telephone | 832-300-8680
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Fax | 832-300-8685
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Authorized Official
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Title or Position | PARTNER
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Name | MR. JASON FORD
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Credential |
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Telephone | 408-666-4685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 68144
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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