Provider Demographics
NPI:1861880981
Name:FULL POTENTIAL: BEHAVIOR INTERVENTION AND SKILLS DEVELOPMENT SERVICES
Entity type:Organization
Organization Name:FULL POTENTIAL: BEHAVIOR INTERVENTION AND SKILLS DEVELOPMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADIMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIKADIBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAGWULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-900-7537
Mailing Address - Street 1:9896 BISSONNET ST
Mailing Address - Street 2:SUITE NUMBER 335
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9896 BISSONNET ST
Practice Address - Street 2:SUITE NUMBER 335
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8104
Practice Address - Country:US
Practice Address - Phone:713-900-7537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X, 103TM1800X, 103TR0400X, 103K00000X
TX23342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty