Provider Demographics
NPI:1275383457
Name:BEHAVIORAL THERAPY OF CLEAR LAKE, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL THERAPY OF CLEAR LAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYLAN
Authorized Official - Middle Name:JERELL
Authorized Official - Last Name:BOOKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:832-756-6251
Mailing Address - Street 1:950 GEMINI ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2730
Mailing Address - Country:US
Mailing Address - Phone:832-224-4783
Mailing Address - Fax:832-284-4247
Practice Address - Street 1:950 GEMINI ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2730
Practice Address - Country:US
Practice Address - Phone:832-224-4783
Practice Address - Fax:832-284-4247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)