MEDICARE: VIBRANT COMPREHENSIVE SERVICES LLC

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	2084P0800X	Psychiatry Physician	Q4831	TX
2	251B00000X	Case Management Agency
3	101YM0800X	Mental Health Counselor		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

General Provider Information

NPI Number	:	1891166518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT COMPREHENSIVE SERVICES LLC

Provider Business Mailing Address
First Line	:	16310 TOMBALL PKWY UNIT 1503
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	252-382-2522
Fax Number	:

Provider Business Practice Location Address
First Line	:	16310 TOMBALL PKWY UNIT 1503
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77064-1812
Country	:	US
Telephone Number	:	252-382-2522
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LOUIS ANTHONY RAWLS
Credential	:
Telephone Number	:	252-382-2522

Provider Enumeration Date	:	10/08/2015
Last Update Date	:	11/22/2023

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