| Accountable Source | |
|
2855a Mangum Rd Suite 502 Houston TX 77092 | |
| (713) 686-8548 | |
| Not Available |
| Full Name | Accountable Source |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2855a Mangum Rd, Houston, Texas |
| Authorized Official Name and Position | David Ikoya (PROGRAM MANAGER) |
| Authorized Official Contact | 7136868548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Accountable Source 2855a Mangum Rd Suite 502 Houston TX 77092 Ph: () - | Accountable Source 2855a Mangum Rd Suite 502 Houston TX 77092 Ph: (713) 686-8548 |
| NPI Number | 1114659893 |
|---|---|
| Provider Enumeration Date | 06/30/2022 |
| Last Update Date | 08/25/2022 |
| Certification Date | 08/25/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114659893 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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