Provider Demographics
NPI:1841593704
Name:TABONO COUNSELING AND MEDIATION CENTER, LLC
Entity Type:Organization
Organization Name:TABONO COUNSELING AND MEDIATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREASA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:281-661-1103
Mailing Address - Street 1:1002 GEMINI ST
Mailing Address - Street 2:SUITE 225G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2746
Mailing Address - Country:US
Mailing Address - Phone:281-661-1103
Mailing Address - Fax:
Practice Address - Street 1:1002 GEMINI ST
Practice Address - Street 2:SUITE 225G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2746
Practice Address - Country:US
Practice Address - Phone:281-661-1103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2012-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66992101YP2500X
TX201521106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty