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General NPI Number Information
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NPI Number | 1609375229
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Entity Type | Organization
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Legal Business Name | MY VIBES LLC
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 02/09/2018
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Provider Practice Location Address
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Address Line | 27158 TRITON DRIVE
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City | SPRING BRANCH
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State | TX
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Zip | 78070
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Country | US
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Telephone | 830-708-0767
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Fax |
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Provider Business Mailing Address
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Address Line | 110 CLEAR POND CRT
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City | SPRING BRANCH
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State | TX
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Zip | 78070
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Country | US
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Telephone | 830-708-0767
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHANNON MALISH
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Credential | LCSW
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Telephone | 830-708-0767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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