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General NPI Number Information
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NPI Number | 1891489100
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Entity Type | Individual
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Provider Name | SEAN RYAN MACKAY
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Gender | Male
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Dates
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Enumeration Date | 06/08/2023
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 8901 GAYLORD DR STE 110
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City | HOUSTON
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State | TX
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Zip | 77024-3047
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Country | US
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Telephone | 713-504-9172
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Fax |
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Provider Business Mailing Address
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Address Line | 1006 WORTHSHIRE ST
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City | HOUSTON
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State | TX
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Zip | 77008-6439
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Country | US
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Telephone | 210-878-5480
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 91692
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License Number State | TX
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