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General NPI Number Information
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NPI Number | 1518463637
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Entity Type | Organization
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Legal Business Name | SOCALREELS
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 16000 STUEBNER AIRLINE RD STE 285
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City | SPRING
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State | TX
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Zip | 77379-7377
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Country | US
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Telephone | 713-300-1867
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Fax | 713-456-2211
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Provider Business Mailing Address
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Address Line | 16000 STUEBNER AIRLINE RD STE 285
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City | SPRING
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State | TX
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Zip | 77379-7377
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Country | US
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Telephone | 713-300-1867
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Fax | 713-456-2211
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | PAULA S TEDDER
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Credential |
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Telephone | 713-300-1867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 202922
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License Number State | TX
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