Organization
FOURTH DIMENSION COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL MICHAEL POOLE LCDC (CEO)
(832) 581-2970
Entity
Organization
Contact information
Practice address
2616 S LOOP W, SUITE 655, HOUSTON, TX 77054-2662
(832) 581-2970
Mailing address
2616 S LOOP W, SUITE 655, HOUSTON, TX 77054-2662
(832) 581-2970
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
3830-3831
TX
302R00000X
Health Maintenance Organization
3830-3831
TX
305R00000X
Preferred Provider Organization
3830-3831
TX
305S00000X
Point of Service
3830-3831
TX
Other
Enumeration date
02/26/2015
Last updated
02/26/2015
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