MEDICARE: PSYCHESYNC LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1235402595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHESYNC LLC

Provider Business Mailing Address
First Line	:	1302 WAUGH DR
Second Line	:	#167
City	:	HOUSTON
State	:	TX
Zip	:	77019-3908
Country	:	US
Telephone Number	:	832-338-9971
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 MERCER ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6508
Country	:	US
Telephone Number	:	832-338-9971
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELODY ALLEN
Credential	:	LPC INTERN
Telephone Number	:	832-338-9971

Provider Enumeration Date	:	02/17/2012
Last Update Date	:	02/17/2012

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Directions to “PSYCHESYNC LLC ” Practice Location

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