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3003 South Loop W # 475 Houston TX 77054-1301 | |
| (713) 383-0888 | |
| (713) 383-0895 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 3003 South Loop W # 475, Houston, Texas |
| Authorized Official Name and Position | Barbara A Candley (CEO) |
| Authorized Official Contact | 7133830888 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3003 South Loop W # 475 Houston TX 77054-1301 Ph: (713) 383-0888 | 3003 South Loop W # 475 Houston TX 77054-1301 Ph: (713) 383-0888 |
| NPI Number | 1275677700 |
|---|---|
| Provider Enumeration Date | 02/17/2007 |
| Last Update Date | 01/10/2014 |
| Medicare PECOS PAC ID | 7012978729 |
|---|---|
| Medicare Enrollment ID | O20041025001040 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275677700 | NPI | - | NPPES |
| 079580901 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | (* (Not Available)) | Primary |
| Provider Name | Barbara A Candley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629112164 PECOS PAC ID: 1153470653 Enrollment ID: I20091006000528 |
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