Organization Name: | INTERNATIONAL THERAPY TEAM PLLC |
NPI Number: | 1063875276 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOCELYN JOHNSON (OWNER) |
Mailing Address: | 1001 Pat Booker Rd Ste. 208 Universal City |
State: | TX US |
Postal Code: | 781484154 |
Phone Number: | 2103648993 |
Fax Number: | |
NPI Enumeration Date: | 04/04/2016 |
NPI Last Update Date: | 05/12/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 70567 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |