=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891820676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY ENRICHMENT CLINIC LTD CO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 04/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7211 REGENCY SQUARE BLVD SUITE #230
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
Fax | 713-780-2838
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7211 REGENCY SQUARE BLVD SUITE #230
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-3138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
Fax | 713-780-2838
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPERVISOR
-----------------------------------------------------
Name | THUY NGUYEN
-----------------------------------------------------
Credential | LMFT, LPC
-----------------------------------------------------
Telephone | 713-780-2833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 16395
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 4947
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------