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2600 S Shore Blvd Ste 332 League City TX 77573-2943 | |
| (720) 841-5789 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor - Professional |
| Location | 2600 S Shore Blvd Ste 332, League City, Texas |
| Authorized Official Name and Position | Cynthia M Davis (OWNER) |
| Authorized Official Contact | 7208415789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2600 S Shore Blvd Ste 332 League City TX 77573-2943 Ph: (720) 841-5789 | 2600 S Shore Blvd Ste 332 League City TX 77573-2943 Ph: (720) 841-5789 |
| NPI Number | 1073003935 |
|---|---|
| Provider Enumeration Date | 05/16/2018 |
| Last Update Date | 12/28/2024 |
| Certification Date | 12/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073003935 | NPI | - | NPPES |
| 1588113179 | Other | NPI TYPE 1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | ACD.0000530 (Colorado) | Secondary |
| 101YP2500X | Counselor - Professional | LPC.0013130 (Colorado) | Primary |
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