Provider Demographics
NPI:1902685472
Name:GOD SMILES MINISTRIES
Entity type:Organization
Organization Name:GOD SMILES MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-816-6646
Mailing Address - Street 1:3139 W HOLCOMBE BLVD # A313
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1533
Mailing Address - Country:US
Mailing Address - Phone:713-816-6646
Mailing Address - Fax:
Practice Address - Street 1:24 GREENWAY PLZ
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-2401
Practice Address - Country:US
Practice Address - Phone:713-816-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder