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27840 Johnson Rd Tomball TX 77375-6455 | |
| (800) 257-8715 | |
| (800) 819-1655 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 27840 Johnson Rd, Tomball, Texas |
| Authorized Official Name and Position | Melissa King (DIRECTOR, CREDENTIALING ENROLLMENT) |
| Authorized Official Contact | 8003703651 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
55 Hatchetts Hill Rd Old Lyme CT 06371-1534 Ph: (800) 370-3651 | 27840 Johnson Rd Tomball TX 77375-6455 Ph: (800) 257-8715 |
| NPI Number | 1992753396 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 07/10/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992753396 | NPI | - | NPPES |
| CB3582 | Other | TX | RAILROAD MEDICARE |
| 136136215 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (Texas) | Primary |
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