Healthcare Provider Details

I. General information

NPI: 1659929131
Provider Name (Legal Business Name): HOUSTON BEHAVIORAL MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 MEMORIAL DR STE 218
HOUSTON TX
77007-8200
US

IV. Provider business mailing address

9337B KATY FWY STE 123
HOUSTON TX
77024-1515
US

V. Phone/Fax

Practice location:
  • Phone: 832-631-9091
  • Fax: 888-616-1650
Mailing address:
  • Phone: 832-631-9091
  • Fax: 888-616-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMAL RAMESH SHAH
Title or Position: CO-FOUNDER
Credential: MD
Phone: 832-631-9091