Provider Demographics
NPI:1053913806
Name:SOVEREIGN
Entity type:Organization
Organization Name:SOVEREIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:MIN,MS, MFT, PHD
Authorized Official - Phone:346-262-3690
Mailing Address - Street 1:9717 CYPRESSWOOD DR APT 1801
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-3270
Mailing Address - Country:US
Mailing Address - Phone:346-376-3690
Mailing Address - Fax:
Practice Address - Street 1:9717 CYPRESSWOOD DR APT 1801
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3270
Practice Address - Country:US
Practice Address - Phone:346-376-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOVEREIGN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health