Individual
MS. PROVILLA HENDERSON SCRUGGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED.
Contact information
Practice address
8303 SOUTHWEST FWY, 640, HOUSTON, TX 77074-1600
(832) 816-8984
(832) 816-8984
Mailing address
13010 FLAXSEED WAY, STAFFORD, TX 77477-3408
(281) 564-4348
(281) 564-4786
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
723
TX
106H00000X
Marriage & Family Therapist
Primary
1929
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
070928901
—
TX
Enumeration date
03/05/2008
Last updated
12/10/2019
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