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13010 Flaxseed Way Stafford TX 77477-3408 | |
| (281) 564-4348 | |
| (281) 564-4786 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 13010 Flaxseed Way, Stafford, Texas |
| Authorized Official Name and Position | Provilla Henderson Scruggs (PRESIDENT) |
| Authorized Official Contact | 2815644348 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13010 Flaxseed Way Stafford TX 77477-3408 Ph: (281) 564-4348 | 13010 Flaxseed Way Stafford TX 77477-3408 Ph: (281) 564-4348 |
| NPI Number | 1265549117 |
|---|---|
| Provider Enumeration Date | 08/24/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265549117 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 1929 (Texas) | Primary |
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