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General NPI Number Information
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NPI Number | 1679668560
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Entity Type | Organization
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Legal Business Name | YVONNE AUGUSTINE
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/09/2007
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Provider Practice Location Address
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Address Line | 1906 TREBLE DR
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City | HUMBLE
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State | TX
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Zip | 77338
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Country | US
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Telephone | 281-446-3740
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Fax | 281-446-8764
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Provider Business Mailing Address
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Address Line | 1442 KINGWOOD DR #103
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City | KINGWOOD
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State | TX
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Zip | 77339
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Country | US
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Telephone | 281-446-3740
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Fax | 281-446-8764
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Authorized Official
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Title or Position | MEDICAL DICTOR PSYCHIATRIC SERVICES
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Name | DR. JAIME GANC
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Credential | MD
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Telephone | 281-446-3740
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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