MEDICARE: NEWSOM PSYCHOLOGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	1041C0700X	Clinical Social Worker
4	103T00000X	Psychologist	31249	TX

General Provider Information

NPI Number	:	1073882338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWSOM PSYCHOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2646 S LOOP W STE 422
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2678
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2646 S LOOP W STE 422
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2678
Country	:	US
Telephone Number	:	713-640-1700
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	WALTER NEWSOM
Credential	:
Telephone Number	:	713-640-1700

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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