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General NPI Number Information
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NPI Number | 1861880981
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Entity Type | Organization
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Legal Business Name | FULL POTENTIAL: BEHAVIOR INTERVENTION AND SKILLS DEVELOPMENT SERVICES
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Dates
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Enumeration Date | 12/23/2014
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Last Update Date | 12/23/2014
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Provider Practice Location Address
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Address Line | 9896 BISSONNET ST SUITE NUMBER 335
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City | HOUSTON
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State | TX
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Zip | 77036-8104
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Country | US
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Telephone | 713-900-7537
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Fax |
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Provider Business Mailing Address
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Address Line | 9896 BISSONNET ST SUITE NUMBER 335
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City | HOUSTON
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State | TX
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Zip | 77036-8104
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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 | ADIMINISTRATOR
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Name | CHIKADIBIE AMAGWULA
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Credential |
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Telephone | 713-900-7537
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 23342
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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