Healthcare Provider Details

I. General information

NPI: 1972269702
Provider Name (Legal Business Name): MODERN PSYCHIATRY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 HOLCOMBE BLVD UNIT 606
HOUSTON TX
77030-4214
US

IV. Provider business mailing address

2001 HOLCOMBE BLVD UNIT 606
HOUSTON TX
77030-4214
US

V. Phone/Fax

Practice location:
  • Phone: 713-714-6305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LI JIN
Title or Position: STAFF
Credential:
Phone: 713-714-6305