Provider Demographics
NPI:1013128974
Name:MICHAEL DOUGLAS SODERSTROM
Entity Type:Organization
Organization Name:MICHAEL DOUGLAS SODERSTROM
Other - Org Name:PINNACLE PAIN MANAGEMENT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:SODERSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-971-0025
Mailing Address - Street 1:2100 BERING DR APT 809
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77057-3745
Mailing Address - Country:US
Mailing Address - Phone:832-971-0025
Mailing Address - Fax:
Practice Address - Street 1:2100 BERING DR APT 809
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-3745
Practice Address - Country:US
Practice Address - Phone:832-971-0025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17891101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty