Provider Demographics
NPI:1629202023
Name:SKINNER, ADRIAN RASHAD
Entity Type:Individual
Prefix:
First Name:ADRIAN RASHAD
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25715 SERENE SPRING LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8465
Mailing Address - Country:US
Mailing Address - Phone:281-714-5121
Mailing Address - Fax:
Practice Address - Street 1:2006 DORMSTOM LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-1736
Practice Address - Country:US
Practice Address - Phone:281-714-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180460101Medicaid