Healthcare Provider Details

I. General information

NPI: 1417891748
Provider Name (Legal Business Name): GENESIS CLINIC & RESEARCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5305 BISSONNET ST STE B
BELLAIRE TX
77401-3967
US

IV. Provider business mailing address

5305 BISSONNET ST STE B
BELLAIRE TX
77401-3967
US

V. Phone/Fax

Practice location:
  • Phone: 713-776-6505
  • Fax: 713-219-9367
Mailing address:
  • Phone: 713-776-6505
  • Fax: 713-219-9367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: HIMANSHU UPADHYAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 713-776-6505