MEDICARE: WEST UNIVERSITY PSYCHOLOGICAL ASSOCIATES

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	103TC1900X	Counseling Psychologist	34766	TX

General Provider Information

NPI Number	:	1750739603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST UNIVERSITY PSYCHOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1712 SUNSET BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1714
Country	:	US
Telephone Number	:	713-927-7514
Fax Number	:

Provider Business Practice Location Address
First Line	:	1712 SUNSET BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77005-1714
Country	:	US
Telephone Number	:	713-927-7514
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	CATHERINE BOSWELL
Credential	:	PHD PSYCHOLOGIST
Telephone Number	:	713-927-7514

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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