Organization
MIP SVC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DINA KUSHALIYEVA (CLINIC DIRECTOR)
(832) 219-8536
Entity
Organization
Contact information
Practice address
2200 NORTH LOOP W STE 106, HOUSTON, TX 77018-1754
(832) 219-8536
Mailing address
2200 NORTH LOOP W STE 106, HOUSTON, TX 77018-1754
(832) 219-8536
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
11/08/2023
Last updated
11/16/2023
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