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General NPI Number Information
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NPI Number | 1750593521
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Entity Type | Organization
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Legal Business Name | JACQUIE YOUTH FOUNDATION
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1506 W ALABAMA ST
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City | HOUSTON
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State | TX
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Zip | 77006-4106
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Country | US
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Telephone | 713-523-0122
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Fax | 713-523-1512
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Provider Business Mailing Address
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Address Line | 1506 W ALABAMA ST
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City | HOUSTON
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State | TX
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Zip | 77006-4106
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Country | US
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Telephone | 713-523-0122
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Fax | 713-523-1512
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JACQUELINE PATTERSON
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Credential |
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Telephone | 713-523-0122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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