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General NPI Number Information
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NPI Number | 1487388641
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Entity Type | Organization
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Legal Business Name | TEXAS ONLINE PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 07/13/2022
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Last Update Date | 07/13/2022
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Provider Practice Location Address
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Address Line | 719 SAWDUST RD STE 210
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City | SPRING
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State | TX
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Zip | 77380-2947
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Country | US
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Telephone | 346-202-7570
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Fax | 346-202-7571
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Provider Business Mailing Address
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Address Line | 17934 FERNWOOD BEND DR
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City | TOMBALL
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State | TX
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Zip | 77377-2459
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JARED HEATHMAN
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Credential | MD
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Telephone | 346-202-7570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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