Healthcare Provider Details

I. General information

NPI: 1518930650
Provider Name (Legal Business Name): DEVEREUX FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 DEVEREUX DR OUTPATIENT CLINIC
LEAGUE CITY TX
77573-2043
US

IV. Provider business mailing address

1150 DEVEREUX DR OUTPATIENT CLINIC
LEAGUE CITY TX
77573-2043
US

V. Phone/Fax

Practice location:
  • Phone: 281-332-8608
  • Fax: 281-332-5283
Mailing address:
  • Phone: 281-332-8608
  • Fax: 281-332-5283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberTMHP083851801
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberTMHP083851801
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberTMHP083851801
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberTMHP083851801
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberTMHP083851801
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberTMHP083851801
License Number StateTX

VIII. Authorized Official

Name: MS. PAMELA E. HELM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 281-335-1000