MEDICARE: AVEO NEUROHEALTH LLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		TX
2	261QH0100X	Health Service Clinic/Center		TX

General Provider Information

NPI Number	:	1114433612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVEO NEUROHEALTH LLC

Provider Business Mailing Address
First Line	:	1880 S DAIRY ASHFORD RD STE 106
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-4759
Country	:	US
Telephone Number	:	303-524-5972
Fax Number	:

Provider Business Practice Location Address
First Line	:	19875 SOUTHWEST FWY STE 100
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-3502
Country	:	US
Telephone Number	:	303-524-5972
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	DR. KENNETH D LANIER
Credential	:	PHARMD
Telephone Number	:	303-524-5972

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	03/17/2018

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Directions to “AVEO NEUROHEALTH LLC ” Practice Location

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