| Abundant Life Therapeutic Services Texas | |
|
260 N Sam Houston Pkwy E Ste 350 Houston TX 77060-2024 | |
| (832) 300-8680 | |
| (832) 300-8685 |
| Full Name | Abundant Life Therapeutic Services Texas |
|---|---|
| Speciality | Case Management |
| Location | 260 N Sam Houston Pkwy E Ste 350, Houston, Texas |
| Authorized Official Name and Position | Jason Ford (PARTNER) |
| Authorized Official Contact | 4086664685 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Abundant Life Therapeutic Services Texas 260 N Sam Houston Pkwy E Ste 350 Houston TX 77060-2024 Ph: (832) 300-8680 | Abundant Life Therapeutic Services Texas 260 N Sam Houston Pkwy E Ste 350 Houston TX 77060-2024 Ph: (832) 300-8680 |
| NPI Number | 1477932119 |
|---|---|
| Provider Enumeration Date | 05/27/2015 |
| Last Update Date | 06/22/2019 |
| Medicare PECOS PAC ID | 4789980103 |
|---|---|
| Medicare Enrollment ID | O20160311000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477932119 | NPI | - | NPPES |
| Provider Name | Edward A Green |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1639171515 PECOS PAC ID: 3870634850 Enrollment ID: I20100427000417 |
| Provider Name | Stacey Rawls |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043249774 PECOS PAC ID: 6901903327 Enrollment ID: I20160111000649 |
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