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General NPI Number Information
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NPI Number | 1790548683
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Entity Type | Organization
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Legal Business Name | EVIDENCE-BUSINESS IMAGE CONSULTING LLC
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Dates
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Enumeration Date | 02/02/2024
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Last Update Date | 02/02/2024
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Provider Practice Location Address
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Address Line | 10468 DEER BRANCH
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City | MISSOURI CITY
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State | TX
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Zip | 77459
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Country | US
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Telephone | 281-961-2802
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Fax |
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Provider Business Mailing Address
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Address Line | 10458 DEER BR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-2463
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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 | DIRECTOR
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Name | KENNETH SANDERS
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Credential |
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Telephone | 281-961-2802
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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 | 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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