Provider Demographics
NPI:1376313619
Name:NORTH STAR CHILD AND FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:NORTH STAR CHILD AND FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JENESSA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-A
Authorized Official - Phone:281-789-8677
Mailing Address - Street 1:33130 MAGNOLIA CIR STE A
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-4169
Mailing Address - Country:US
Mailing Address - Phone:281-789-8667
Mailing Address - Fax:
Practice Address - Street 1:33130 MAGNOLIA CIR STE A21
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3277
Practice Address - Country:US
Practice Address - Phone:281-789-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health