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General NPI Number Information
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NPI Number | 1700487816
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Entity Type | Organization
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Legal Business Name | TOTAL RESTORATION BEHAVIORAL SCIENCE AND COUNSELING CENTER
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 9823 BRILLIANT LAKE DR
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City | HUMBLE
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State | TX
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Zip | 77396-1570
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Country | US
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Telephone | 301-556-8665
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Fax |
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Provider Business Mailing Address
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Address Line | 9659 N SAM HOUSTON PKWY E # 227
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City | HUMBLE
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State | TX
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Zip | 77396-1529
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Country | US
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Telephone | 301-556-8665
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. EARNEST LEE PUGH
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Credential | MDIV, DMIN
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Telephone | 301-556-8665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health 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 | 261QP0904X
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Taxonomy Name | Federal Public Health Clinic/Center
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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 | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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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 | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 310500000X
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Taxonomy Name | Mental Illness Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #9
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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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