MEDICARE: TRIVEDI PSYCHOLOGICAL SERVICES, 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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1841611043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIVEDI PSYCHOLOGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	3919 R V MAYFIELD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-5648
Country	:	US
Telephone Number	:	281-451-8112
Fax Number	:	855-271-3371

Provider Business Practice Location Address
First Line	:	1415 NORTH LOOP W STE 616
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-2278
Country	:	US
Telephone Number	:	281-451-8112
Fax Number	:	855-271-3371

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	SHILPA B TRIVEDI
Credential	:	PSY. D.
Telephone Number	:	281-451-8112

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	05/05/2020

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