MEDICARE: NORTH HOUSTON PSYCHIATRY, PLLC

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	2084P0800X	Psychiatry Physician	N3676	TX

General Provider Information

NPI Number	:	1164719795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH HOUSTON PSYCHIATRY, PLLC

Provider Business Mailing Address
First Line	:	14335 TORREY CHASE BLVD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1634
Country	:	US
Telephone Number	:	281-631-0081
Fax Number	:	281-583-7748

Provider Business Practice Location Address
First Line	:	14335 TORREY CHASE BLVD STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77014-1634
Country	:	US
Telephone Number	:	281-631-0081
Fax Number	:	281-583-7748

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JENNINGS TYSON GODSY
Credential	:	M.D.
Telephone Number	:	281-631-0081

Provider Enumeration Date	:	07/04/2011
Last Update Date	:	07/04/2011

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