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General NPI Number Information
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NPI Number | 1497126122
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Entity Type | Organization
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Legal Business Name | MPP MSO PLLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 550 WESTCOTT ST SUITE 520
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City | HOUSTON
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State | TX
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Zip | 77007-9015
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Country | US
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Telephone | 336-864-6694
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Fax |
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Provider Business Mailing Address
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Address Line | 550 WESTCOTT ST SUITE 520
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City | HOUSTON
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State | TX
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Zip | 77007-9015
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Country | US
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Telephone | 336-864-6694
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | VALARIE DOUGLAS
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Credential |
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Telephone | 336-856-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | Q228
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | Q228
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | P3036
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | H4516
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License Number State | TX
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Taxonomy #6
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | P3036
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License Number State | TX
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Taxonomy #7
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 626781
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License Number State | TX
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Taxonomy #8
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | H4183
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License Number State | TX
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