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General NPI Number Information
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NPI Number | 1780372995
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Entity Type | Organization
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Legal Business Name | AWARE THERAPEUTIC SERVICES, PLLC
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Dates
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Enumeration Date | 04/26/2023
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Last Update Date | 04/26/2023
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Provider Practice Location Address
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Address Line | 5210 PRAIRIE TERRACE LN
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City | FULSHEAR
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State | TX
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Zip | 77441-2199
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Country | US
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Telephone | 832-780-3035
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 UPLAND DRIVE PMB 5087
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City | HOUSTON
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State | TX
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Zip | 77043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DESIREE SHANKLE
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Credential |
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Telephone | 832-780-3035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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