Organization · NPI-2

Active Ketamine, PLLC

Psychiatry & Neurology, Pain Medicine · Houston, TX

NPI number1073259156
StatusActive
Last updated in NPPESMay 11, 2022

Details

NPI
1073259156
Entity type
Organization (NPI-2)
Legal business name
Active Ketamine, PLLC
Organization subpart
No
Enumeration date
May 11, 2022
Certification date
May 11, 2022
Last updated
May 11, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2084P2900X Psychiatry & Neurology, Pain Medicine––Yes

Practice location

12250 Queenston Blvd Ste E
Houston, TX 77095-5343

Phone 281-201-4511

Mailing address

12250 Queenston Blvd Ste E
Houston, TX 77095-5343

Authorized official

Jared Heathman
Managing Member
2812014511

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