Provider Demographics
NPI:1174063994
Name:REGENERATION BEHAVORIAL HEALTH LLC
Entity type:Organization
Organization Name:REGENERATION BEHAVORIAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:832-530-4352
Mailing Address - Street 1:6699 CHIMNEY ROCK RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081
Mailing Address - Country:US
Mailing Address - Phone:832-530-4352
Mailing Address - Fax:
Practice Address - Street 1:6699 CHIMNEY ROCK RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081
Practice Address - Country:US
Practice Address - Phone:832-530-4352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty