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General NPI Number Information
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NPI Number | 1811711427
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Entity Type | Organization
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Legal Business Name | ASTRONUAT SWAGG LLC
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1110 CALDER ST STE 130
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City | BEAUMONT
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State | TX
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Zip | 77701-1777
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Country | US
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Telephone | 409-225-8383
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Fax |
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Provider Business Mailing Address
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Address Line | 2415 AVENUE A
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City | NEDERLAND
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State | TX
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Zip | 77627-6013
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Country | US
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Telephone | 409-225-8383
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MS. COURTNEY JACOBS
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Credential |
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Telephone | 409-225-8383
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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