=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699133686
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAXIMUM PSYCH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2016
-----------------------------------------------------
Last Update Date | 02/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5322 SAN PABLO GARDENS DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77045-4061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-212-9701
-----------------------------------------------------
Fax | 713-513-5585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5322 SAN PABLO GARDENS DR
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77045-4061
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-212-9701
-----------------------------------------------------
Fax | 713-513-5585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | AISHA HARRIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-212-9701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------