Provider Demographics
NPI:1366984684
Name:PRACTICE INTERGRATED BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PRACTICE INTERGRATED BEHAVIORAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HOUSEWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, LBSW
Authorized Official - Phone:832-248-4636
Mailing Address - Street 1:150 PINE FOREST DRIVE
Mailing Address - Street 2:SUITE 802
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384
Mailing Address - Country:US
Mailing Address - Phone:832-248-4636
Mailing Address - Fax:866-804-7241
Practice Address - Street 1:627 W 19TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:832-248-4636
Practice Address - Fax:866-804-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty