Provider Demographics
NPI: | 1871859538 |
---|---|
Name: | INSPIRING YOUTH CENTER |
Entity type: | Organization |
Organization Name: | INSPIRING YOUTH CENTER |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | GIA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COOPER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 832-850-8071 |
Mailing Address - Street 1: | 21110 N BASILDON CT |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77073-2941 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 832-250-8071 |
Mailing Address - Fax: | 832-250-8071 |
Practice Address - Street 1: | 21110 N BASILDON CT |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77073-2941 |
Practice Address - Country: | US |
Practice Address - Phone: | 832-250-8071 |
Practice Address - Fax: | 832-250-8017 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | INSPIRING YOIUTH CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2012-04-06 |
Last Update Date: | 2012-04-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |