| Genesis Family Foundation Llc | |
|
1110 Nasa Pkwy Ste 201 Houston TX 77058-3359 | |
| (713) 913-4575 | |
| Not Available |
| Full Name | Genesis Family Foundation Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 1110 Nasa Pkwy Ste 201, Houston, Texas |
| Authorized Official Name and Position | Rens Daniel De Koning (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3462084147 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Family Foundation Llc 1110 Nasa Pkwy Ste 201 Houston TX 77058-3359 Ph: (713) 913-4575 | Genesis Family Foundation Llc 1110 Nasa Pkwy Ste 201 Houston TX 77058-3359 Ph: (713) 913-4575 |
| NPI Number | 1366145542 |
|---|---|
| Provider Enumeration Date | 03/24/2023 |
| Last Update Date | 03/24/2023 |
| Certification Date | 03/24/2023 |
| Medicare PECOS PAC ID | 5496191140 |
|---|---|
| Medicare Enrollment ID | O20240315002592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366145542 | NPI | - | NPPES |
| 1063113645 | Other | TX | NPI OF PROVIDER AT OUR ORGANIZATION |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Tanya L De Koning |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1063113645 PECOS PAC ID: 0446696116 Enrollment ID: I20240315003698 |
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