Provider Demographics
NPI:1780937722
Name:FRIENDSWOOD COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:FRIENDSWOOD COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:OTTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, LPC
Authorized Official - Phone:479-200-6034
Mailing Address - Street 1:3526 E FM 528 RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-5014
Mailing Address - Country:US
Mailing Address - Phone:479-200-6034
Mailing Address - Fax:281-819-7845
Practice Address - Street 1:3526 E FM 528 RD
Practice Address - Street 2:SUITE 208
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-5014
Practice Address - Country:US
Practice Address - Phone:479-200-6034
Practice Address - Fax:281-819-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66163251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTPI-216419601Medicaid