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General NPI Number Information
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NPI Number | 1760005045
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Entity Type | Organization
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Legal Business Name | FAMILY ALLIANCE NETWORK LLC
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 5206 CYPRESS CREEK PKWY STE 104
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City | HOUSTON
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State | TX
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Zip | 77069-4405
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Country | US
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Telephone | 832-446-3221
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Fax | 832-666-2975
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Provider Business Mailing Address
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Address Line | 5206 CYPRESS CREEK PKWY STE 104
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City | HOUSTON
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State | TX
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Zip | 77069-4405
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Country | US
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Telephone | 832-446-3221
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Fax | 832-666-2975
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SABRINA A MACK
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Credential |
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Telephone | 832-446-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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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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