Provider Demographics
NPI:1497178917
Name:IICOM STRATEGIC LLC DBA UNIQUE MIND CARE
Entity Type:Organization
Organization Name:IICOM STRATEGIC LLC DBA UNIQUE MIND CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-660-1100
Mailing Address - Street 1:1776 YORKTOWN ST
Mailing Address - Street 2:STE 550
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-4182
Mailing Address - Country:US
Mailing Address - Phone:713-660-1100
Mailing Address - Fax:
Practice Address - Street 1:1776 YORKTOWN ST
Practice Address - Street 2:STE 550
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-4182
Practice Address - Country:US
Practice Address - Phone:713-660-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysisGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00D84ROtherBCBS