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General NPI Number Information
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NPI Number | 1548936438
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Entity Type | Organization
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Legal Business Name | LONE STAR STATE HEALTH
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 9894 BISSONNET ST STE 710
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City | HOUSTON
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State | TX
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Zip | 77036-8244
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Country | US
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Telephone | 305-504-4259
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Fax |
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Provider Business Mailing Address
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Address Line | 9894 BISSONNET ST STE 710
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City | HOUSTON
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State | TX
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Zip | 77036-8244
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Country | US
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Telephone | 305-504-4259
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. FALLON JACKSON
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Credential |
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Telephone | 305-504-4259
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #6
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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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