Provider Demographics
NPI:1619353471
Name:INNOVATIVE COUNSELING OPTIONS OF HOUSTON PLLC
Entity Type:Organization
Organization Name:INNOVATIVE COUNSELING OPTIONS OF HOUSTON PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:2819-469-5670
Mailing Address - Street 1:5900 MEMORIAL DR STE 218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8008
Mailing Address - Country:US
Mailing Address - Phone:281-946-9567
Mailing Address - Fax:281-496-2108
Practice Address - Street 1:5900 MEMORIAL DR STE 218
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8008
Practice Address - Country:US
Practice Address - Phone:281-946-9567
Practice Address - Fax:281-496-2108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2017-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX522981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX440856Medicare UPIN