MEDICARE: CHISOM IKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033314802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHISOM IKE

Provider Business Mailing Address
First Line	:	9119 S GESSNER RD STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2845
Country	:	US
Telephone Number	:	713-771-1550
Fax Number	:	713-771-5968

Provider Business Practice Location Address
First Line	:	9119 S GESSNER RD STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2845
Country	:	US
Telephone Number	:	713-771-1550
Fax Number	:	713-771-5968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	07/29/2024

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Directions to “ CHISOM IKE ” Practice Location

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