Provider Demographics
NPI:1427561810
Name:ASE BEHAVIORAL HEALTH AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:ASE BEHAVIORAL HEALTH AND WELLNESS, PLLC
Other - Org Name:METAMORPHOSIS BEHAVIORAL SUPPORT & PSYCHOTHERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/LEAD CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:PEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LPC
Authorized Official - Phone:713-714-3800
Mailing Address - Street 1:PO BOX 15931
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77220-5931
Mailing Address - Country:US
Mailing Address - Phone:713-714-3800
Mailing Address - Fax:
Practice Address - Street 1:5604 1/2 LOS ANGELES ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77026-2330
Practice Address - Country:US
Practice Address - Phone:713-714-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74141101YM0800X
251B00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase Management