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General NPI Number Information
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NPI Number | 1821538687
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Entity Type | Organization
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Legal Business Name | OPTIMIZE MIND CARE, LLC
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Dates
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Enumeration Date | 02/27/2017
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Last Update Date | 02/27/2017
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Provider Practice Location Address
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Address Line | 2302 FANNIN ST SUITE 500A
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City | HOUSTON
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State | TX
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Zip | 77002-9143
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Country | US
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Telephone | 713-882-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 2302 FANNIN ST SUITE 500A
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City | HOUSTON
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State | TX
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Zip | 77002-9143
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Country | US
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Telephone | 713-882-9370
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | LARA LOUISE CHRISTIAN
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Credential | MA, LPC, BCN
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Telephone | 713-882-9370
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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 | 75721
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License Number State | TX
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