Healthcare Provider Details

I. General information

NPI: 1972877199
Provider Name (Legal Business Name): PSYGEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 SUGAR CREEK CENTER BLVD STE 250
SUGAR LAND TX
77478-3691
US

IV. Provider business mailing address

4007 WATERVIEW CT
MISSOURI CITY TX
77459-2309
US

V. Phone/Fax

Practice location:
  • Phone: 281-494-8666
  • Fax: 281-265-5127
Mailing address:
  • Phone: 281-403-6240
  • Fax: 281-265-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number32600
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number32600
License Number State

VIII. Authorized Official

Name: DR. SHARON W CHADA
Title or Position: VICE-PRESIDENT
Credential: PH.D.
Phone: 281-494-8666