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, HOUSTON, TX 77092-7405
(713) 686-8548
Mailing address
2855A MANGUM RD, HOUSTON, TX 77092-7405
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
Other
Enumeration date
06/21/2022
Last updated
11/01/2022
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