Provider Demographics
NPI:1619245693
Name:BACK IN THE SADDLE PSYCHOTHERAPY, INC.
Entity Type:Organization
Organization Name:BACK IN THE SADDLE PSYCHOTHERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VELASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, EAP
Authorized Official - Phone:713-203-3529
Mailing Address - Street 1:8255 CAMP SIENNA TRL
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6061
Mailing Address - Country:US
Mailing Address - Phone:713-203-3529
Mailing Address - Fax:281-494-1315
Practice Address - Street 1:8255 CAMP SIENNA TRL
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6061
Practice Address - Country:US
Practice Address - Phone:713-203-3529
Practice Address - Fax:281-494-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39119251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health