Provider Demographics
NPI:1275097115
Name:SHALOM MENTAL HEALTH
Entity Type:Organization
Organization Name:SHALOM MENTAL HEALTH
Other - Org Name:SHALOM MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EKOW
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAKYE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-739-9720
Mailing Address - Street 1:18815 PRIMROSE EDGE CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-1114
Mailing Address - Country:US
Mailing Address - Phone:832-739-9720
Mailing Address - Fax:
Practice Address - Street 1:16727 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1311
Practice Address - Country:US
Practice Address - Phone:832-739-9720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390342901Medicaid