MEDICARE: PERSONAL GROWTH ASSOCIATES

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	101YP2500X	Professional Counselor	11961	TX
2	106H00000X	Marriage & Family Therapist	4082	TX

General Provider Information

NPI Number	:	1548422793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL GROWTH ASSOCIATES

Provider Business Mailing Address
First Line	:	957 NASA ROAD ONE, #193
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-435-4788
Fax Number	:	713-856-8006

Provider Business Practice Location Address
First Line	:	6300 WEST LOOP S STE 500
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2903
Country	:	US
Telephone Number	:	281-435-4788
Fax Number	:	713-856-8006

Authorized Official
Title or Position	:	OFFICE MGR
Name	:	KYRA JONES
Credential	:
Telephone Number	:	713-856-8005

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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Directions to “PERSONAL GROWTH ASSOCIATES ” Practice Location

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