=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982077103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAGAMOSLO.ORG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2015
-----------------------------------------------------
Last Update Date | 11/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2501 S MASON RD STE 237
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-201-5647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 S MASON RD STE 237
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77450-1789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-201-5647
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXCUTIVE DIRECTOR
-----------------------------------------------------
Name | DR. MARIANGELA GALBAN RUBIO
-----------------------------------------------------
Credential | MA
-----------------------------------------------------
Telephone | 281-201-5647
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavioral Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------