Organization
ACCOUNTABLE SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID IKOYA (PROGRAM MANAGER)
(713) 686-8548
Entity
Organization
Contact information
Practice address
2855A MANGUM RD, SUITE 502, HOUSTON, TX 77092
(713) 686-8548
Mailing address
2855A MANGUM RD, SUITE 502, HOUSTON, TX 77092
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/30/2022
Last updated
08/25/2022
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