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General NPI Number Information
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NPI Number | 1932579505
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Entity Type | Organization
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Legal Business Name | CHAMPION THERAPY
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 09/25/2015
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Provider Practice Location Address
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Address Line | 25435 FM 2978 SUITE 108
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City | TOMBALL
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State | TX
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Zip | 77375
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Country | US
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Telephone | 281-813-7894
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Fax | 888-638-6067
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Provider Business Mailing Address
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Address Line | 268 ARGOSY LN
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City | MONTGOMERY
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State | TX
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Zip | 77316-6858
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Country | US
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Telephone | 281-813-7894
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Fax | 888-638-6067
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | GLORIA RENEE TRAWEEK
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Credential | LCSW
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Telephone | 281-813-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 32515
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License Number State | TX
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