Provider Demographics
NPI:1366651374
Name:THE PRISM CENTER, P.A.
Entity Type:Organization
Organization Name:THE PRISM CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT -CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTANA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:832-778-6750
Mailing Address - Street 1:6750 WEST LOOP S
Mailing Address - Street 2:SUITE 950
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4103
Mailing Address - Country:US
Mailing Address - Phone:832-778-6750
Mailing Address - Fax:832-778-6752
Practice Address - Street 1:6750 WEST LOOP S
Practice Address - Street 2:SUITE 950
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4103
Practice Address - Country:US
Practice Address - Phone:832-778-6750
Practice Address - Fax:832-778-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherUNITED BEHAVIORAL HEALTH