| Proactive Interventions, Llc | |
|
8955 Broadway St Apt 10184 Houston TX 77061-3052 | |
| (225) 284-8671 | |
| Not Available |
| Full Name | Proactive Interventions, Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 8955 Broadway St Apt 10184, Houston, Texas |
| Authorized Official Name and Position | Johnalynn Moran Jackson (OWNER/CEO) |
| Authorized Official Contact | 2252848671 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Proactive Interventions, Llc 8955 Broadway St Apt 10184 Houston TX 77061-3052 Ph: () - | Proactive Interventions, Llc 8955 Broadway St Apt 10184 Houston TX 77061-3052 Ph: (225) 284-8671 |
| NPI Number | 1821592569 |
|---|---|
| Provider Enumeration Date | 03/19/2018 |
| Last Update Date | 03/19/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821592569 | NPI | - | NPPES |
| 1679087308 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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