MEDICARE: SELF MENTAL HEALTH THERAPY, PLLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1124810452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELF MENTAL HEALTH THERAPY, PLLC

Provider Business Mailing Address
First Line	:	8215 LONG POINT RD STE 41
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2746
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8215 LONG POINT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77055-2059
Country	:	US
Telephone Number	:	832-280-7330
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST, OWNER
Name	:	JOUMANA AZZAM
Credential	:	LCSW
Telephone Number	:	832-280-7330

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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