Provider Demographics
NPI:1871056499
Name:CAPACITY AWAKENED, PLLC
Entity type:Organization
Organization Name:CAPACITY AWAKENED, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CICELIA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:COMO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:409-363-0292
Mailing Address - Street 1:5900 MEMORIAL DR STE 218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8008
Mailing Address - Country:US
Mailing Address - Phone:832-975-0276
Mailing Address - Fax:
Practice Address - Street 1:5900 MEMORIAL DR STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8008
Practice Address - Country:US
Practice Address - Phone:832-975-0276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty