MONA MENTORS COMMUNITY AGENCY

Provider Demographics

• NPI: 1134543507
• Name: MONA MENTORS COMMUNITY AGENCY
• Entity type: Organization
• Organization Name: MONA MENTORS COMMUNITY AGENCY
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: PRESIDENT
• Authorized Official - First Name: MONA
• Authorized Official - Middle Name: SWAFFORD
• Authorized Official - Last Name: ELLIS
• Authorized Official - Credentials: MS, CHW
• Authorized Official - Phone: 713-266-2090
• Mailing Address - Street 1: 1339 MACCLESBY LN
• Mailing Address - City: CHANNELVIEW
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77530-4822
• Mailing Address - Country: US
• Mailing Address - Phone: 713-266-2090
• Mailing Address - Fax: 800-434-4305
• Practice Address - Street 1: 507 N SAM HOUSTON PKWY E
• Practice Address - Street 2: SUITE 125
• Practice Address - City: HOUSTON
• Practice Address - State: TX
• Practice Address - Zip Code: 77060-4021
• Practice Address - Country: US
• Practice Address - Phone: 713-266-2090
• Practice Address - Fax: 800-434-4305
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2014-02-06
• Last Update Date: 2014-07-07

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	251S00000X	Agencies	Community/Behavioral Health
No	251B00000X	Agencies	Case Management		Group - Single Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Single Specialty
No	101YP2500X	Behavioral Health & Social Service Providers	Counselor	Professional	Group - Single Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Single Specialty
No	101YA0400X	Behavioral Health & Social Service Providers	Counselor	Addiction (Substance Use Disorder)	Group - Single Specialty
No	101YP1600X	Behavioral Health & Social Service Providers	Counselor	Pastoral	Group - Single Specialty
No	172V00000X	Other Service Providers	Community Health Worker		Group - Single Specialty