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General NPI Number Information
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NPI Number | 1689058240
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL HEALTH SOURCE
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 952 ECHO LN STE 335
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City | HOUSTON
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State | TX
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Zip | 77024-2792
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Country | US
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Telephone | 713-984-2121
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55039
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City | HOUSTON
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State | TX
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Zip | 77255-5039
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Country | US
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Telephone | 713-984-2121
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SAMUEL E LEE
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Credential | PH.D.
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Telephone | 713-984-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13830
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License Number State | TX
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