MEDICARE: ASCENSION PSYCHIATRIC SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2084B0040X	Behavioral Neurology & Neuropsychiatry Physician
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261QM1300X	Multi-Specialty Clinic/Center
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner
6	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417553751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION PSYCHIATRIC SERVICES LLC

Provider Business Mailing Address
First Line	:	156 MALONE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-8115
Country	:	US
Telephone Number	:	713-702-2670
Fax Number	:	832-834-5181

Provider Business Practice Location Address
First Line	:	156 MALONE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-8115
Country	:	US
Telephone Number	:	713-702-2670
Fax Number	:	832-834-5181

Authorized Official
Title or Position	:	OWNER
Name	:	CYNTHIA SCOTT
Credential	:
Telephone Number	:	713-702-2670

Provider Enumeration Date	:	12/10/2020
Last Update Date	:	03/22/2021

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