Provider Demographics
NPI:1003015777
Name:SIGHBENN HEALING AND CULTURAL PLACE
Entity Type:Organization
Organization Name:SIGHBENN HEALING AND CULTURAL PLACE
Other - Org Name:LIFE CENTER HEALING AND CULTURAL PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MISSID
Authorized Official - Middle Name:G
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, PSYD
Authorized Official - Phone:281-367-0328
Mailing Address - Street 1:26515 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1966
Mailing Address - Country:US
Mailing Address - Phone:281-367-0328
Mailing Address - Fax:281-419-9753
Practice Address - Street 1:26515 OAK RIDGE DR
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1966
Practice Address - Country:US
Practice Address - Phone:281-367-0328
Practice Address - Fax:281-419-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26864103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1619082617OtherINDIVIDUAL NPI
TX097011302Medicaid
TX8F7646Medicare PIN
TX097011302Medicaid