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General NPI Number Information
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NPI Number | 1124518121
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Entity Type | Organization
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Legal Business Name | DEER OAKS PSY
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 03/23/2020
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Provider Practice Location Address
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Address Line | 17070 RED OAK DR STE 209
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City | HOUSTON
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State | TX
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Zip | 77090-2615
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Country | US
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Telephone | 832-225-3345
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Fax | 713-583-1504
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Provider Business Mailing Address
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Address Line | 17070 RED OAK DR STE 209
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City | HOUSTON
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State | TX
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Zip | 77090-2615
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Country | US
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Telephone | 832-225-3345
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW MATTERN
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Credential |
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Telephone | 832-439-6320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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