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General NPI Number Information
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NPI Number | 1831623743
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Entity Type | Organization
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Legal Business Name | TISS LIVING CENTERS
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/18/2017
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Provider Practice Location Address
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Address Line | 18210 ETON RIDGE CT
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City | RICHMOND
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State | TX
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Zip | 77469-0000
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Country | US
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Telephone | 713-298-9731
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Fax |
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Provider Business Mailing Address
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Address Line | 18210 ETON RIDGE CT
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City | RICHMOND
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State | TX
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Zip | 77469-0000
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Country | US
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Telephone | 713-298-9731
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TEMISAN M DUCKSWORTH
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Credential |
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Telephone | 713-298-9731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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