Provider Demographics
NPI:1558744623
Name:HOUSTON GALVESTON INSTITUTE
Entity Type:Organization
Organization Name:HOUSTON GALVESTON INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:281-415-1145
Mailing Address - Street 1:2702 PINE NEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-5522
Mailing Address - Country:US
Mailing Address - Phone:281-415-1145
Mailing Address - Fax:
Practice Address - Street 1:2990 RICHMOND AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3104
Practice Address - Country:US
Practice Address - Phone:713-526-8390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty