Provider Demographics
NPI: | 1437478617 |
---|---|
Name: | SECOND STEP |
Entity Type: | Organization |
Organization Name: | SECOND STEP |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | DANIEL |
Authorized Official - Last Name: | ROBINSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 936-581-1252 |
Mailing Address - Street 1: | 121 BRIAR MDW |
Mailing Address - Street 2: | |
Mailing Address - City: | HUNTSVILLE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77320-1952 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 936-581-1252 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3010 MONTGOMERY RD |
Practice Address - Street 2: | |
Practice Address - City: | HUNTSVILLE |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77340-6022 |
Practice Address - Country: | US |
Practice Address - Phone: | 936-581-1252 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-05-27 |
Last Update Date: | 2010-05-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 15617 | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Single Specialty |