Healthcare Provider Details

I. General information

NPI: 1184037525
Provider Name (Legal Business Name): RELIANT PARK PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 FANNIN ST
HOUSTON TX
77054-1905
US

IV. Provider business mailing address

7601 FANNIN ST
HOUSTON TX
77054-1905
US

V. Phone/Fax

Practice location:
  • Phone: 713-795-8874
  • Fax: 713-795-5529
Mailing address:
  • Phone: 713-795-8874
  • Fax: 713-795-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberN8002
License Number StateTX

VIII. Authorized Official

Name: IZZELDEEN BABIKER ELHAGE
Title or Position: M.D
Credential: M.D
Phone: 267-307-7251