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NPI Code Detail

MEDICARE: CONCRETE ROSE COUNSELING

MEDICARE: CONCRETE ROSE COUNSELING
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
1101Y00000XCounselor20180TX
2101YA0400XAddiction (Substance Use Disorder) Counselor20180TX
3101YM0800XMental Health Counselor20180TX
4106H00000XMarriage & Family Therapist20180TX
5101YP2500XProfessional Counselor20180TX

General Provider Information

NPI Number : 1326231150
Entity Type Code : Organization
Provider Name (Legal Business Name) : CONCRETE ROSE COUNSELING
Provider Business Mailing Address
First Line : 12806 GLORYWHITE CT
Second Line :
City : HOUSTON
State : TX
Zip : 77034-3685
Country : US
Telephone Number : 832-563-8623
Fax Number :
Provider Business Practice Location Address
First Line : 1319 LIVE OAK ST
Second Line :
City : HOUSTON
State : TX
Zip : 77003-4408
Country : US
Telephone Number : 832-563-8623
Fax Number :
Authorized Official
Title or Position : PSYCHO-THERAPIST
Name : ERIC S WELLS
Credential : LPC, LSTOP
Telephone Number : 832-563-8623
Provider Enumeration Date : 08/24/2007
Last Update Date : 08/24/2007

Similar Medicare Providers

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Practice Location Address:
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1245300706 — DR. LESAJEAN M JENNINGS PSY.D.
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1407046105 — DR. BERNADINE DUNCAN L.P.C.
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Practice Fax:
1972860369 — LESAJEAN M. JENNINGS, PSY.D.
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77003-4408
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1922430263 — MRS. CHRISTINA ALYCE RUNNELS MA, LPC
Practice Location Address:
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1851784474 — S. N. OKOLO & ASSOCIATES
Practice Location Address:
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Directions to “CONCRETE ROSE COUNSELING ” Practice Location

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