Provider Demographics
NPI:1134496532
Name:ACCOUNTABLE SOURCE
Entity Type:Organization
Organization Name:ACCOUNTABLE SOURCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GULLESE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-212-2131
Mailing Address - Street 1:3737 MANGUM RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77092-5407
Mailing Address - Country:US
Mailing Address - Phone:832-212-2131
Mailing Address - Fax:
Practice Address - Street 1:2855A MANGUM RD.
Practice Address - Street 2:STE 502
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77092-5407
Practice Address - Country:US
Practice Address - Phone:832-212-2131
Practice Address - Fax:832-686-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251C00000X, 261QM0850X, 261QM0855X, 323P00000X, 385HR2055X
TX0000302F00000X
TX305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251B00000XAgenciesCase Management
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000OtherN/A