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General NPI Number Information
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NPI Number | 1609093707
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Entity Type | Organization
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Legal Business Name | CPRC HOLDING LLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 25134 OAKHURST DR
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City | SPRING
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State | TX
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Zip | 77386-1421
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Country | US
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Telephone | 281-630-3721
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Fax |
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Provider Business Mailing Address
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Address Line | 25134 OAKHURST DR
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City | SPRING
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State | TX
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Zip | 77386-1421
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Country | US
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Telephone | 281-630-3721
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | GLENN BRICKEN
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Credential | PSYD
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Telephone | 281-364-0067
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 60602
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License Number State | TX
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