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General NPI Number Information
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NPI Number | 1881024974
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Entity Type | Organization
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Legal Business Name | GMC RESTORATIVE THERAPY
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 2616 S LOOP W
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 713-661-3233
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Fax | 713-904-2455
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Provider Business Mailing Address
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Address Line | 2616 S LOOP W
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City | HOUSTON
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State | TX
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Zip | 77054-2662
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Country | US
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Telephone | 713-661-3233
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Fax | 713-904-2455
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JANICE LEONARD
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Credential | MEDIATOR
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Telephone | 713-661-3233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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