MEDICARE: GERIATRIC MENTAL HEALTH SPECIALISTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053439380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERIATRIC MENTAL HEALTH SPECIALISTS INC

Provider Business Mailing Address
First Line	:	66 CANDLE PINE PL # 100
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-6436
Country	:	US
Telephone Number	:	800-746-7284
Fax Number	:	936-273-3786

Provider Business Practice Location Address
First Line	:	8039 SCYENE CIR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75227-5534
Country	:	US
Telephone Number	:	214-388-0424
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DENISE ORTEGA
Credential	:
Telephone Number	:	800-746-7284

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	02/23/2012

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