Provider Demographics
NPI:1902650575
Name:NEURODEVELOPMENT CENTER OF GREATER HOUSTON
Entity Type:Organization
Organization Name:NEURODEVELOPMENT CENTER OF GREATER HOUSTON
Other - Org Name:NEURODEVELOPMENT CENTER OF GREATER HOUSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DEVELOPMENTAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:COKER
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-881-6877
Mailing Address - Street 1:1304 BLODGETT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5011
Mailing Address - Country:US
Mailing Address - Phone:281-881-6877
Mailing Address - Fax:
Practice Address - Street 1:4203 MONTROSE BLVD STE 290
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5470
Practice Address - Country:US
Practice Address - Phone:281-881-6877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRAL FLOW, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty