Provider Demographics
NPI:1356739031
Name:PEARLAND PLACE
Entity type:Organization
Organization Name:PEARLAND PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BOB
Authorized Official - Middle Name:ROGER
Authorized Official - Last Name:PALUSZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:281-222-4326
Mailing Address - Street 1:3606 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9190
Mailing Address - Country:US
Mailing Address - Phone:281-222-4326
Mailing Address - Fax:
Practice Address - Street 1:2225 COUNTY ROAD 90
Practice Address - Street 2:219
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4890
Practice Address - Country:US
Practice Address - Phone:281-222-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-02
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64883101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty