MEDICARE: CORE COMMUNITY CARE, 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1255606711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORE COMMUNITY CARE, PLLC

Provider Business Mailing Address
First Line	:	2828 BAMMEL LN
Second Line	:	#1000
City	:	HOUSTON
State	:	TX
Zip	:	77098-1148
Country	:	US
Telephone Number	:	832-533-1531
Fax Number	:	281-742-2573

Provider Business Practice Location Address
First Line	:	2616 S LOOP W
Second Line	:	SUITE 585
City	:	HOUSTON
State	:	TX
Zip	:	77054-2662
Country	:	US
Telephone Number	:	832-533-1531
Fax Number	:	281-742-2573

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. CARMEL O'REARDON
Credential	:	LCSW
Telephone Number	:	832-533-1531

Provider Enumeration Date	:	03/16/2012
Last Update Date	:	03/16/2012

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