Provider Demographics
NPI:1801371919
Name:CARSON PARKE
Entity type:Organization
Organization Name:CARSON PARKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:832-539-3794
Mailing Address - Street 1:262 N SAM HOUSTON PKWY E
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-2027
Mailing Address - Country:US
Mailing Address - Phone:281-305-4444
Mailing Address - Fax:281-305-4500
Practice Address - Street 1:262 N SAM HOUSTON PKWY E
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-2027
Practice Address - Country:US
Practice Address - Phone:281-305-4444
Practice Address - Fax:281-305-4500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children