| Southeast Texas Child Guidance Center, Pllc | |
|
3250 Medical Center Dr Beaumont TX 77701-4627 | |
| (409) 813-1765 | |
| (409) 813-1875 |
| Full Name | Southeast Texas Child Guidance Center, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 3250 Medical Center Dr, Beaumont, Texas |
| Authorized Official Name and Position | Ravikumar Kanneganti (OWNER/DIRECTOR) |
| Authorized Official Contact | 4098131765 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Texas Child Guidance Center, Pllc Po Box 21313 Beaumont TX 77720-1313 Ph: (409) 813-1765 | Southeast Texas Child Guidance Center, Pllc 3250 Medical Center Dr Beaumont TX 77701-4627 Ph: (409) 813-1765 |
| NPI Number | 1861761017 |
|---|---|
| Provider Enumeration Date | 12/16/2011 |
| Last Update Date | 05/05/2015 |
| Medicare PECOS PAC ID | 5991952632 |
|---|---|
| Medicare Enrollment ID | O20120830000723 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861761017 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Ravikumar Kanneganti |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1679643191 PECOS PAC ID: 5395919161 Enrollment ID: I20111114000756 |
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