Provider Demographics
NPI: | 1760715684 |
---|---|
Name: | FOUNTAIN COUNSELING AND DEVELOPMENTAL SERVICES |
Entity Type: | Organization |
Organization Name: | FOUNTAIN COUNSELING AND DEVELOPMENTAL SERVICES |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AKONDAYE |
Authorized Official - Middle Name: | SAVONDA |
Authorized Official - Last Name: | TURNER-FOUNTAIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 713-465-4194 |
Mailing Address - Street 1: | 10575 KATY FWY STE 428 |
Mailing Address - Street 2: | |
Mailing Address - City: | HOUSTON |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 77024-1023 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-465-4194 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 10575 KATY FWY STE 428 |
Practice Address - Street 2: | |
Practice Address - City: | HOUSTON |
Practice Address - State: | TX |
Practice Address - Zip Code: | 77024-1023 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-465-4194 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-09-09 |
Last Update Date: | 2009-09-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 20215 | 251S00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251S00000X | Agencies | Community/Behavioral Health |