Provider Demographics
NPI:1124819321
Name:BODY AND MIND RENEWAL HTX
Entity type:Organization
Organization Name:BODY AND MIND RENEWAL HTX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:SHATERRIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-848-4232
Mailing Address - Street 1:13134 HAWKINS BND
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-1430
Mailing Address - Country:US
Mailing Address - Phone:210-848-4232
Mailing Address - Fax:
Practice Address - Street 1:8525 N SAM HOUSTON PKWY E STE 704
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-5229
Practice Address - Country:US
Practice Address - Phone:281-436-9684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty