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General NPI Number Information
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NPI Number | 1518269802
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Entity Type | Organization
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Legal Business Name | PSYCHIATRIC SERVICES ROGER HOUSE, M.D.
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Dates
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Enumeration Date | 11/19/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 2401 SUMMERHILL RD STE A
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City | TEXARKANA
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State | TX
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Zip | 75501-3570
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Country | US
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Telephone | 903-792-4779
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Fax | 903-792-4693
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Provider Business Mailing Address
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Address Line | 2401 SUMMERHILL RD STE A
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City | TEXARKANA
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State | TX
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Zip | 75501-3570
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Country | US
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Telephone | 903-792-4779
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Fax | 903-792-4693
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Authorized Official
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Title or Position | M.D.
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Name | DR. ROGER HOUSE SR.
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Credential | M.D.
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Telephone | 903-792-4779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 67139
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License Number State | TX
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