Provider Demographics
NPI:1174990329
Name:ASCENT PSYCHOTHERAPY CENTER
Entity type:Organization
Organization Name:ASCENT PSYCHOTHERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUYKENDALL-ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-418-2479
Mailing Address - Street 1:1795 N FRY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-3347
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3880 GREENHOUSE RD
Practice Address - Street 2:SUITE 412
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6792
Practice Address - Country:US
Practice Address - Phone:832-418-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16445101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096040303Medicaid