MEDICARE: ATCG 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	1041C0700X	Clinical Social Worker
2	103TC0700X	Clinical Psychologist

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	:	1497786636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATCG LLC

Provider Business Mailing Address
First Line	:	PO BOX 14673
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77347-4673
Country	:	US
Telephone Number	:	281-260-0821
Fax Number	:	281-260-0352

Provider Business Practice Location Address
First Line	:	4225 DENMARK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-6801
Country	:	US
Telephone Number	:	713-631-0200
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	MS. PATRICIA A JOHNS
Credential	:
Telephone Number	:	281-260-0821

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	04/08/2014

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Directions to “ATCG LLC ” Practice Location

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