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General NPI Number Information
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NPI Number | 1780937722
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Entity Type | Organization
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Legal Business Name | FRIENDSWOOD COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 3526 E FM 528 RD SUITE 208
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5014
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Country | US
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Telephone | 479-200-6034
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Fax | 281-819-7845
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Provider Business Mailing Address
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Address Line | 3526 E FM 528 RD SUITE 208
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City | FRIENDSWOOD
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State | TX
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Zip | 77546-5014
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Country | US
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Telephone | 479-200-6034
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Fax | 281-819-7845
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Authorized Official
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Title or Position | CLINICAL THERAPIST
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Name | KRISTI OTTIS
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Credential | MS, NCC, LPC
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Telephone | 479-200-6034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 66163
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License Number State | TX
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