MEDICARE: ABIDING CHRISTIAN THERAPY, LLC

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	252Y00000X	Early Intervention Provider Agency
2	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205871860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABIDING CHRISTIAN THERAPY, LLC

Provider Business Mailing Address
First Line	:	12655 WOODFOREST BLVD STE 700
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3575
Country	:	US
Telephone Number	:	713-453-2300
Fax Number	:	713-453-2300

Provider Business Practice Location Address
First Line	:	7703 BRIDLE PATH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-2709
Country	:	US
Telephone Number	:	281-458-1967
Fax Number	:	281-458-1967

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. PENNY LEZAK
Credential	:	LPC
Telephone Number	:	713-453-2300

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	10/18/2021

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