| Ellie Mental Health - Houston Clear Lake | |
|
2200 Space Park Dr Ste 240 Houston TX 77058-3677 | |
| (346) 857-5319 | |
| Not Available |
| Full Name | Ellie Mental Health - Houston Clear Lake |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 2200 Space Park Dr Ste 240, Houston, Texas |
| Authorized Official Name and Position | Corey Kauffman (CEO) |
| Authorized Official Contact | 3468575319 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ellie Mental Health - Houston Clear Lake 621 Power St League City TX 77573-5539 Ph: (346) 857-5319 | Ellie Mental Health - Houston Clear Lake 2200 Space Park Dr Ste 240 Houston TX 77058-3677 Ph: (346) 857-5319 |
| NPI Number | 1053038273 |
|---|---|
| Provider Enumeration Date | 10/27/2022 |
| Last Update Date | 07/18/2023 |
| Certification Date | 07/18/2023 |
| Medicare PECOS PAC ID | 9638530090 |
|---|---|
| Medicare Enrollment ID | O20230801002890 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053038273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | David R Castele |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922657113 PECOS PAC ID: 5799146155 Enrollment ID: I20230801003045 |
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