MEDICARE: DR. ATHENA PATELIS PH.D.

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	15736	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	1689690083	OTHER	TX	MEDICARE
3	319968YVY8	OTHER	TX	MEDICARE (UNDER KRIST SAMARITAN COUNSELING)
4	00583E	OTHER	TX	MEDICARE
5	175072671	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86406A	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1841208931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ATHENA PATELIS PH.D.

Provider Business Mailing Address
First Line	:	16441 SPACE CENTER BLVD, SUITE C-100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058
Country	:	US
Telephone Number	:	281-480-7554
Fax Number	:	281-480-4641

Provider Business Practice Location Address
First Line	:	16441 SPACE CENTER BLVD # C100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2015
Country	:	US
Telephone Number	:	281-480-7554
Fax Number	:	281-480-4641

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	03/08/2026

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Directions to “ DR. ATHENA PATELIS PH.D.” Practice Location

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