MEDICARE: OUTMN FORD

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1538949425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OUTMN FORD

Provider Business Mailing Address
First Line	:	13700 VETERANS MEMORIAL DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1017
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13700 VETERANS MEMORIAL DR STE 100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1017
Country	:	US
Telephone Number	:	832-840-0806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	09/29/2023

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Directions to “ OUTMN FORD ” Practice Location

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