Healthcare Provider Details

I. General information

NPI: 1265160519
Provider Name (Legal Business Name): MH PSYCH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2022
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1345 SPACE PARK DR STE C
HOUSTON TX
77058-3469
US

IV. Provider business mailing address

1345 SPACE PARK DR STE C
HOUSTON TX
77058-3469
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-2284
  • Fax: 281-333-0221
Mailing address:
  • Phone: 281-333-2284
  • Fax: 281-333-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GEORGE R BRAZZEL
Title or Position: CEO
Credential: LPC, LMFT
Phone: 281-333-2284