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10330 Lake Rd Ste R Houston TX 77070-1886 | |
| (346) 200-6260 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Counselor |
| Location | 10330 Lake Rd Ste R, Houston, Texas |
| Authorized Official Name and Position | Sarah Rodriguez (OWNER/ DIRECTOR OF MENTAL HEALTH) |
| Authorized Official Contact | 3462006260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
17711 Sugar Magnolia Ln Spring TX 77379-1643 Ph: (956) 249-1485 | 10330 Lake Rd Ste R Houston TX 77070-1886 Ph: (346) 200-6260 |
| NPI Number | 1588358105 |
|---|---|
| Provider Enumeration Date | 06/06/2023 |
| Last Update Date | 09/17/2024 |
| Certification Date | 09/17/2024 |
| Medicare PECOS PAC ID | 8224569231 |
|---|---|
| Medicare Enrollment ID | O20241001004502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588358105 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Sarah Rodriguez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457069890 PECOS PAC ID: 9133650146 Enrollment ID: I20241001004512 |
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