MEDICARE: CHISOM IKE

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1841973971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHISOM IKE

Provider Business Mailing Address
First Line	:	9119 S GESSNER RD STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2845
Country	:	US
Telephone Number	:	713-771-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	9119 S GESSNER RD STE 201
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-2845
Country	:	US
Telephone Number	:	713-771-1550
Fax Number	:	713-771-5968

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	CHISOM IKE
Credential	:
Telephone Number	:	713-409-0685

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “CHISOM IKE ” Practice Location

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