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General NPI Number Information
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NPI Number | 1538604152
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Entity Type | Organization
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Legal Business Name | CERTUSLOGUE, PLLC
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/05/2017
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Provider Practice Location Address
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Address Line | 11211 KATY FWY SUITE 285
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City | HOUSTON
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State | TX
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Zip | 77079-2126
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Country | US
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Telephone | 713-632-4658
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Fax |
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Provider Business Mailing Address
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Address Line | 815 CARLINGFORD LN
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City | HOUSTON
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State | TX
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Zip | 77079-3204
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Country | US
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Telephone | 713-632-4658
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CONNIE VILLASMIL
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Credential | LCSW
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Telephone | 713-632-4658
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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 | 56541
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License Number State | TX
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