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Organization
MAE BETH'S PLACE
Active
Organization
MAE BETH'S PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROSE MARIE JACKSON LMSW-AP (DIRECTOR)
(832) 519-5784
Entity
Organization
Contact information
Practice address
15002 MONRAD DR, HOUSTON, TX 77053-1345
(832) 519-5784
Mailing address
15002 MONRAD DR, HOUSTON, TX 77053-1345
(832) 519-5784
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
722757925
MEDICAID TICKET NUMBER
TX
Enumeration date
06/10/2009
Last updated
06/10/2009
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