Provider Demographics
NPI:1568861169
Name:POSITIVE SUPPORT
Entity Type:Organization
Organization Name:POSITIVE SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-658-6925
Mailing Address - Street 1:10206 ELLA LEE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-2940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10700 RICHMOND AVE
Practice Address - Street 2:STE 147
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4925
Practice Address - Country:US
Practice Address - Phone:281-658-6925
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17697101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Single Specialty