Provider Demographics
NPI:1144597956
Name:MONA MENTORS COMMUNITY AGENCY, INC.
Entity Type:Organization
Organization Name:MONA MENTORS COMMUNITY AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:P/CHW
Authorized Official - Phone:713-266-2090
Mailing Address - Street 1:1339 MACCLESBY LN
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4822
Mailing Address - Country:US
Mailing Address - Phone:713-266-2080
Mailing Address - Fax:800-434-4305
Practice Address - Street 1:6420 RICHMOND AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5929
Practice Address - Country:US
Practice Address - Phone:713-266-2080
Practice Address - Fax:800-434-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12165OtherTHHS