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Provider Information for 1609456433


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GLADYS JEFFERSON-HOLLIS


Sex: Female

NPI: 1609456433
Last Updated: 2021-04-14
Certification Date: 2021-04-12

Details

NameValue
NPI1609456433
Enumeration Date2021-04-14
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 5600 S WILLOW DR STE 203
HOUSTON, TX 77035-4700
United States

Phone: 832-775-3493 | Fax:
 
Primary Practice Address 5600 S WILLOW DR STE 203
HOUSTON, TX 77035-4700
United States

Phone: 832-775-3493 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Direct Messaging Address
admin@rayofhope.us
Direct CSV Ray of Hope Healthcare Services LLC 5600 S Willow Dr
Houston, TX 77035-4713
United States
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDTX820748994
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 193200000X - Multi-Specialty Group
101Y00000X - Counselor