Provider Demographics
NPI:1568187730
Name:INNER AND OUTER GLOW, PLLC
Entity Type:Organization
Organization Name:INNER AND OUTER GLOW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:K'BREAUN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-862-8792
Mailing Address - Street 1:701 N POST OAK RD STE 145
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-3923
Mailing Address - Country:US
Mailing Address - Phone:713-364-6275
Mailing Address - Fax:
Practice Address - Street 1:701 N POST OAK RD STE 145
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-3923
Practice Address - Country:US
Practice Address - Phone:713-364-6275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-10
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty