Provider Demographics
NPI:1518463637
Name:SOCALREELS
Entity Type:Organization
Organization Name:SOCALREELS
Other - Org Name:CHAMPIONS COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:S
Authorized Official - Last Name:TEDDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-300-1867
Mailing Address - Street 1:16000 STUEBNER AIRLINE RD STE 285
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7377
Mailing Address - Country:US
Mailing Address - Phone:713-300-1867
Mailing Address - Fax:713-456-2211
Practice Address - Street 1:16000 STUEBNER AIRLINE RD STE 285
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7377
Practice Address - Country:US
Practice Address - Phone:713-300-1867
Practice Address - Fax:713-456-2211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-05
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202922106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX384095101Medicaid