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General NPI Number Information
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NPI Number | 1871096388
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Entity Type | Organization
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Legal Business Name | KINGWOOD TMS & PSYCHIATRY
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Dates
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Enumeration Date | 03/10/2018
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Last Update Date | 03/12/2018
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Provider Practice Location Address
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Address Line | 20550 TOWNSEN BLVD STE 101
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City | HUMBLE
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State | TX
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Zip | 77338-4445
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Country | US
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Telephone | 832-879-2107
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Fax | 832-442-5044
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Provider Business Mailing Address
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Address Line | 20550 TOWNSEN BLVD STE 101
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City | HUMBLE
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State | TX
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Zip | 77338-4445
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Country | US
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Telephone | 832-879-2107
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Fax | 832-442-5044
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. JIMMIE EVANS JR.
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Credential | BSM
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Telephone | 832-879-2107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2083A0100X
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Taxonomy Name | Aerospace Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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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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