Organization
ACCOUNTABLE SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GULLESE D SCOTT (PRESIDENT)
(832) 212-2131
Entity
Organization
Contact information
Practice address
5710 CENTRALCREST ST, HOUSTON, TX 77092-7004
(713) 686-8548
(713) 686-8559
Mailing address
5710 CENTRALCREST ST, HOUSTON, TX 77092-7004
(713) 686-8548
(713) 686-8559
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
302F00000X
Exclusive Provider Organization
0000
TX
305S00000X
Point of Service
—
TX
323P00000X
Psychiatric Residential Treatment Facility
—
—
385HR2055X
Child Mental Illness Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
N/A
TX
Enumeration date
11/30/2011
Last updated
03/21/2025
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