=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710870522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHAMPIONS MENTAL HEALTH & WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2025
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13810 CHAMPION FOREST DR STE 150
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-1883
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-487-5854
-----------------------------------------------------
Fax | 713-597-5897
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5214 ROTHCHILDE CT
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-1545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-898-5400
-----------------------------------------------------
Fax | 713-597-5897
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | MARYANN CUNNINGHAM MATHESON
-----------------------------------------------------
Credential | PMHNP-BC, GNP-BC
-----------------------------------------------------
Telephone | 713-898-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------