=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497092233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER HORIZONS COMMUNITY SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2013
-----------------------------------------------------
Last Update Date | 01/14/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27703 GUTHRIE RIDGE LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-437-6284
-----------------------------------------------------
Fax | 832-437-2831
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27703 GUTHRIE RIDGE LN
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77494-3331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-437-6284
-----------------------------------------------------
Fax | 832-437-2831
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PAMELA ETTA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 832-437-6284
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------