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630 Colony Lake Estates Dr Apt 1014 Stafford TX 77477-4675 | |
| (832) 273-9481 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 630 Colony Lake Estates Dr Apt 1014, Stafford, Texas |
| Authorized Official Name and Position | Sonia Malhotra (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8322739481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2121 El Paseo St Apt 1108 Houston TX 77054-3223 Ph: (832) 273-9481 | 630 Colony Lake Estates Dr Apt 1014 Stafford TX 77477-4675 Ph: (832) 273-9481 |
| NPI Number | 1851930515 |
|---|---|
| Provider Enumeration Date | 12/29/2019 |
| Last Update Date | 02/09/2020 |
| Certification Date | 02/09/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851930515 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Secondary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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