Provider Demographics
NPI:1548613342
Name:IMANI COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:IMANI COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-501-0091
Mailing Address - Street 1:10333 HARWIN DR STE 490
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-1532
Mailing Address - Country:US
Mailing Address - Phone:281-501-0091
Mailing Address - Fax:832-553-7811
Practice Address - Street 1:10333 HARWIN DR STE 490
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1532
Practice Address - Country:US
Practice Address - Phone:281-501-0091
Practice Address - Fax:832-553-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66339101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX379233501Medicaid
TX309244702Medicaid