=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588484315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUEBONNET FAMILY PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2024
-----------------------------------------------------
Last Update Date | 01/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 25420 KUYKENDAHL RD STE A200
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-3409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-520-2450
-----------------------------------------------------
Fax | 832-922-4635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24520 KUYKENDAHL RD A200
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-520-2450
-----------------------------------------------------
Fax | 832-922-4635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HUMERA DANWAR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 832-310-8014
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------