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NPI Code Detail

MEDICARE: NORTH STAR CHILD AND FAMILY THERAPY, PLLC

MEDICARE: NORTH STAR CHILD AND FAMILY 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
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1376313619
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH STAR CHILD AND FAMILY THERAPY, PLLC
Provider Business Mailing Address
First Line : 33130 MAGNOLIA CIR STE A
Second Line :
City : MAGNOLIA
State : TX
Zip : 77354-4169
Country : US
Telephone Number : 281-789-8667
Fax Number :
Provider Business Practice Location Address
First Line : 33130 MAGNOLIA CIR STE A21
Second Line :
City : MAGNOLIA
State : TX
Zip : 77354-3277
Country : US
Telephone Number : 281-789-8677
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : JENESSA LOUISE RIVAS
Credential : LPC-A
Telephone Number : 281-789-8677
Provider Enumeration Date : 01/08/2024
Last Update Date : 03/21/2024

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Directions to “NORTH STAR CHILD AND FAMILY THERAPY, PLLC ” Practice Location

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