Basic Information
| Provider Information | |||||||||
| NPI: | 1124679477 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AZURITE COUNSELING AND WELLNESS, PLLC | ||||||||
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| OtherOrganizationName: | AZURITE COUNSELING AND WELLNESS, PLLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8703 MEADOWCROFT DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770635006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | 7138407957 | ||||||||
| Practice Location | |||||||||
| Address1: | 8703 MEADOWCROFT DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770635006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | 7138407957 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2019 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | HUSSAIN | ||||||||
| AuthorizedOfficialFirstName: | VIQAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7138407956 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QM0850X | Y | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.