PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES (SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE) - NPI NUMBER 1457398489

Summary

Provider Name: PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES (SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE)

NPI Number: 1457398489

Clasification: Specialist (174400000X)

Address:
4314 YOAKUM BLVD
HOUSTON, TX
ZIP 77006

Phone Number: (713) 850-0049



Detailed Information

PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES is a specialist in Houston, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. The assigned NPI number for this provider is 1457398489 and is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Senior Psychiatric Connection Or Senior Psychcare.

The provider's business address is:

4314 YOAKUM BLVD
HOUSTON, TX
ZIP 77006-818
Phone: (713) 850-0049
Fax: (713) 627-7302

The provider's authorized official is Leo James Borrell .
The authorized official title is President and has the following contact phone number (713) 850-0049.

The enumeration date for this NPI number is 5/31/2006 and was last updated on 10/5/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 174400000X Specialist Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 146806801 MEDICAID TX
2 145260901 MEDICAID TX
3 00621R MEDICARE PIN TX
4 145260902 MEDICAID TX
5 00620R MEDICARE PIN TX
6 00W454 MEDICARE PIN TX
7 00622R MEDICARE PIN TX

NPI Record

No. Field Name Field Value
1 NPI 1457398489
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name PSYCHIATRIC SERVICES OF HOUSTON & ASSOCIATES
5 Provider Other Organization Name SENIOR PSYCHIATRIC CONNECTION OR SENIOR PSYCHCARE
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 4314 YOAKUM BLVD
8 Provider Business Practice Location Address City Name HOUSTON
9 Provider Business Practice Location Address State Name TX
10 Provider Business Practice Location Address Postal Code 770065818
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 7138500049
13 Provider Business Practice Location Address Fax Number 7136277302
14 Provider Enumeration Date 5/31/2006
15 Last Update Date 10/5/2011
16 Authorized Official Last Name BORRELL
17 Authorized Official First Name LEO
18 Authorized Official Middle Name JAMES
19 Authorized Official Title or Position PRESIDENT
20 Authorized Official Telephone Number 7138500049
21 Healthcare Provider Taxonomy Code 1 174400000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 146806801
24 Other Provider Identifier Type Code 1 05
25 Other Provider Identifier State 1 TX
26 Other Provider Identifier 2 145260901
27 Other Provider Identifier Type Code 2 05
28 Other Provider Identifier State 2 TX
29 Other Provider Identifier 3 00621R
30 Other Provider Identifier Type Code 3 08
31 Other Provider Identifier State 3 TX
32 Other Provider Identifier 4 145260902
33 Other Provider Identifier Type Code 4 05
34 Other Provider Identifier State 4 TX
35 Other Provider Identifier 5 00620R
36 Other Provider Identifier Type Code 5 08
37 Other Provider Identifier State 5 TX
38 Other Provider Identifier 6 00W454
39 Other Provider Identifier Type Code 6 08
40 Other Provider Identifier State 6 TX
41 Other Provider Identifier 7 00622R
42 Other Provider Identifier Type Code 7 08
43 Other Provider Identifier State 7 TX
44 Is Organization Subpart N
45 Authorized Official Name Prefix Text DR.
46 Authorized Official Credential Text M.D.
47 Healthcare Provider Taxonomy Group 1 193400000X SINGLE SPECIALTY GROUP

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This page was last updated on: 9/11/2014
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