Organization
MEMORIAL HERMANN
Active
Organization
MEMORIAL HERMANN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AVA PROFOTA LPC (CLINICAL MANAGER)
(713) 868-2908
Entity
Organization
Contact information
Practice address
2000 NORTH LOOP W, STE 200, HOUSTON, TX 77018-8124
(713) 868-2908
Mailing address
5518 SANTA CHASE LN, SUGAR LAND, TX 77479-5402
(832) 630-3653
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
19747
TX
Other
Enumeration date
03/13/2007
Last updated
01/29/2008
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