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General NPI Number Information
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NPI Number | 1891154266
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Entity Type | Organization
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Legal Business Name | ZEN IMAGO PLLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 4800 SUGAR GROVE BLVD SUITE 528
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City | STAFFORD
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State | TX
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Zip | 77477
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Country | US
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Telephone | 832-782-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 9119 HIGHWAY 6 SOUTH SUITE 189
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City | MISSOURI CITY
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State | TX
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Zip | 77459
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Country | US
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Telephone | 832-782-0001
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LOLA CLAY
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Credential | MS, LPC-S
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Telephone | 832-782-0001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 63309
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License Number State | TX
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