Provider Demographics
NPI:1811242126
Name:FAMILY TREE
Entity type:Organization
Organization Name:FAMILY TREE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:RASHANNA
Authorized Official - Last Name:HAMBRICK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:832-657-5958
Mailing Address - Street 1:8531 WILD BASIN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-8019
Mailing Address - Country:US
Mailing Address - Phone:832-657-5958
Mailing Address - Fax:
Practice Address - Street 1:8531 WILD BASIN DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-8019
Practice Address - Country:US
Practice Address - Phone:832-657-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health