Provider Demographics
NPI:1366145542
Name:GENESIS FAMILY FOUNDATION LLC
Entity type:Organization
Organization Name:GENESIS FAMILY FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENS DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DE KONING
Authorized Official - Suffix:
Authorized Official - Credentials:CPRC
Authorized Official - Phone:346-208-4147
Mailing Address - Street 1:1110 NASA PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3359
Mailing Address - Country:US
Mailing Address - Phone:713-913-4575
Mailing Address - Fax:
Practice Address - Street 1:1110 NASA PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3359
Practice Address - Country:US
Practice Address - Phone:713-913-4575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1063113645OtherNPI OF PROVIDER AT OUR ORGANIZATION