Provider Demographics
NPI: | 1407535461 |
---|---|
Name: | YOUR SAFE PLACE LLC |
Entity Type: | Organization |
Organization Name: | YOUR SAFE PLACE LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SHARAIN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | JOHNSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 832-755-5457 |
Mailing Address - Street 1: | 2626 S LOOP W STE 425 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77054-2652 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-635-9760 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2626 S LOOP W STE 425 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77054-2652 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-635-9760 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2023-07-17 |
Last Update Date: | 2024-04-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YS0200X | Behavioral Health & Social Service Providers | Counselor | School | Group - Multi-Specialty |
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Single Specialty | |
Yes | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Single Specialty |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness | Group - Single Specialty |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | Group - Single Specialty | |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | Group - Single Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
No | 251B00000X | Agencies | Case Management | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |