=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962369561
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRIUMPH RECOVERY AND COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2026
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13231 CHAMPION FOREST DR STE 206
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-405-7764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13231 CHAMPION FOREST DR STE 206
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77069-2647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-405-7764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | ANTHONY BERNARD JACKSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 832-405-7764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------