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General NPI Number Information
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NPI Number | 1871501932
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL ASSOCIATES OF CLEAR LAKE
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1560 LIVE OAK ST SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598-4147
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Country | US
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Telephone | 281-554-6100
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Fax | 281-554-6133
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Provider Business Mailing Address
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Address Line | 1560 LIVE OAK ST SUITE B
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City | WEBSTER
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State | TX
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Zip | 77598-4147
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Country | US
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Telephone | 281-554-6100
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Fax | 281-554-6133
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL JONES
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Credential | PH.D.
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Telephone | 281-554-6100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23621
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License Number State | TX
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