Provider Demographics
NPI:1710623087
Name:TANGLEWOOD BEHAVIORAL HEALTH GROUP PC
Entity Type:Organization
Organization Name:TANGLEWOOD BEHAVIORAL HEALTH GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:RIVER
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:832-931-7596
Mailing Address - Street 1:1220 AUGUSTA DR STE 290
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-2261
Mailing Address - Country:US
Mailing Address - Phone:832-931-7596
Mailing Address - Fax:832-391-8219
Practice Address - Street 1:1220 AUGUSTA DR STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-2261
Practice Address - Country:US
Practice Address - Phone:832-931-7596
Practice Address - Fax:832-391-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700307675OtherNPI INDIVIDUAL