Provider Demographics
NPI:1073756417
Name:HOUSTON ADVANCED MEDILINE CLINIC
Entity Type:Organization
Organization Name:HOUSTON ADVANCED MEDILINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-669-0848
Mailing Address - Street 1:6550 MAPLERIDGE ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-4600
Mailing Address - Country:US
Mailing Address - Phone:713-669-0848
Mailing Address - Fax:713-669-0648
Practice Address - Street 1:6550 MAPLERIDGE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-4600
Practice Address - Country:US
Practice Address - Phone:713-669-0848
Practice Address - Fax:713-669-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty