MEDICARE: MRS. BRIANA MIGNON HEARD CHARVIS

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	261QF0400X	Federally Qualified Health Center (FQHC)
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1033927165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIANA MIGNON HEARD CHARVIS

Provider Business Mailing Address
First Line	:	9757 PINE LAKE DR APT 1076
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-6152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 JACQUELYN DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2502
Country	:	US
Telephone Number	:	713-462-6565
Fax Number	:

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

Provider Enumeration Date	:	12/20/2024
Last Update Date	:	04/03/2025

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