Organization
ACTIVE KETAMINE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED HEATHMAN (MANAGING MEMBER)
(281) 201-4511
Entity
Organization
Contact information
Practice address
12250 QUEENSTON BLVD STE E, HOUSTON, TX 77095-5343
(281) 201-4511
Mailing address
12250 QUEENSTON BLVD STE E, HOUSTON, TX 77095-5343
Taxonomy
Speciality
Code
Description
License number
State
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
05/11/2022
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