=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801833298
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARGOSY MENTAL HEALTH SERVICES P A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2006
-----------------------------------------------------
Last Update Date | 01/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 531 GASLIGHT BLVD
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75904-3127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-632-7010
-----------------------------------------------------
Fax | 903-694-9591
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 154011
-----------------------------------------------------
City | LUFKIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75915-4011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-632-7010
-----------------------------------------------------
Fax | 903-694-9591
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEORGE S PARK
-----------------------------------------------------
Credential | PH.D
-----------------------------------------------------
Telephone | 936-632-7010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 24724
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------