Healthcare Provider Details

I. General information

NPI: 1124518121
Provider Name (Legal Business Name): DEER OAKS PSY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17070 RED OAK DR STE 209
HOUSTON TX
77090-2615
US

IV. Provider business mailing address

17070 RED OAK DR STE 209
HOUSTON TX
77090-2615
US

V. Phone/Fax

Practice location:
  • Phone: 832-225-3345
  • Fax: 713-583-1504
Mailing address:
  • Phone: 832-225-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MATTERN
Title or Position: OWNER
Credential:
Phone: 832-439-6320