MEDICARE: IMANI COUNSELING SERVICES, 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	101YP2500X	Professional Counselor	66339	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548613342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMANI COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	10333 HARWIN DR STE 490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1532
Country	:	US
Telephone Number	:	281-501-0091
Fax Number	:	832-553-7811

Provider Business Practice Location Address
First Line	:	10333 HARWIN DR STE 490
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-1532
Country	:	US
Telephone Number	:	281-501-0091
Fax Number	:	832-553-7811

Authorized Official
Title or Position	:	OWNER
Name	:	KRYSTAL HUMPHREY
Credential	:	LPC
Telephone Number	:	281-501-0091

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	05/09/2019

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