MEDICARE: TANGLEWOOD BEHAVIORAL HEALTH GROUP PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700307675	OTHER	TX	NPI INDIVIDUAL

General Provider Information

NPI Number	:	1710623087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TANGLEWOOD BEHAVIORAL HEALTH GROUP PC

Provider Business Mailing Address
First Line	:	1220 AUGUSTA DR STE 290
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2261
Country	:	US
Telephone Number	:	832-931-7596
Fax Number	:	832-391-8219

Provider Business Practice Location Address
First Line	:	1220 AUGUSTA DR STE 290
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77057-2261
Country	:	US
Telephone Number	:	832-931-7596
Fax Number	:	832-391-8219

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	DR. CHRISTINE RIVER BLOCK
Credential	:	PHD, LCSW
Telephone Number	:	832-931-7596

Provider Enumeration Date	:	05/10/2022
Last Update Date	:	05/10/2022

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