MEDICARE: DENNIS SLATE PSYD

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	103TC0700X	Clinical Psychologist	33518	TX

General Provider Information

NPI Number	:	1598952012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS SLATE PSYD

Provider Business Mailing Address
First Line	:	8610 SILVER LURE DR
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-8140
Country	:	US
Telephone Number	:	281-796-1485
Fax Number	:

Provider Business Practice Location Address
First Line	:	5330 GRIGGS RD
Second Line	:	SUITE B-108
City	:	HOUSTON
State	:	TX
Zip	:	77021-3700
Country	:	US
Telephone Number	:	713-533-0022
Fax Number	:	713-533-9915

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	04/17/2008

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