Provider Demographics
NPI:1386882124
Name:CHURCH OF CHRIST IN FRIENDSWOOD
Entity type:Organization
Organization Name:CHURCH OF CHRIST IN FRIENDSWOOD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-482-3882
Mailing Address - Street 1:2051 W PARKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-8910
Mailing Address - Country:US
Mailing Address - Phone:281-482-3882
Mailing Address - Fax:281-482-9430
Practice Address - Street 1:2051 W PARKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-8910
Practice Address - Country:US
Practice Address - Phone:281-482-3882
Practice Address - Fax:281-482-9430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHURCH OF CHRIT IN FRIENDSWOOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06173251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health