Provider Demographics
NPI:1174226203
Name:CONGO, JAMELIA
Entity type:Individual
Prefix:
First Name:JAMELIA
Middle Name:
Last Name:CONGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 REMINGTON HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-4439
Mailing Address - Country:US
Mailing Address - Phone:713-591-4860
Mailing Address - Fax:
Practice Address - Street 1:211 REMINGTON HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-4439
Practice Address - Country:US
Practice Address - Phone:713-591-4860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX1806-0323175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health