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General NPI Number Information
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NPI Number | 1740961424
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Entity Type | Organization
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Legal Business Name | SAGACIOUS BEAUTY LLC.
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 07/26/2023
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Provider Practice Location Address
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Address Line | 16770 IMPERIAL VALLEY DR STE 125E
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City | HOUSTON
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State | TX
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Zip | 77060-3427
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Country | US
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Telephone | 832-264-5293
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2063
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City | HUMBLE
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State | TX
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Zip | 77347-2063
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Country | US
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Telephone | 346-803-6955
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Fax |
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Authorized Official
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Title or Position | CASE MANAGER
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Name | JUNE WILLIAMS FULLER
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Credential |
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Telephone | 832-264-5293
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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 #3
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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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Taxonomy #4
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Taxonomy Code | 1744P3200X
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Taxonomy Name | Prosthetics Case Management
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License Number |
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License Number State |
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