=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902100266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY MEDICAL AND MENTAL HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2010
-----------------------------------------------------
Last Update Date | 12/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9898 BISSONNET ST STE 470
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-0810
-----------------------------------------------------
Fax | 866-924-6348
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9898 BISSONNET ST STE 470
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77036-8280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-541-0810
-----------------------------------------------------
Fax | 866-924-6348
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. CHEDRIC COX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 713-541-0810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | K1739
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | K1739
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------