MEDICARE: OASIS MIND AND BODY

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1174035398
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OASIS MIND AND BODY

Provider Business Mailing Address
First Line	:	3301 PLAINVIEW ST STE 1
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:	281-612-9565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 PLAINVIEW ST STE 1
Second Line	:
City	:	PASADENA
State	:	TX
Zip	:	77504-1929
Country	:	US
Telephone Number	:	281-612-9565
Fax Number	:

Authorized Official
Title or Position	:	CHIEF OPERATIONS ASSISTANT
Name	:	DIAMOND GALLOW
Credential	:
Telephone Number	:	281-612-9565

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	10/27/2017

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Directions to “OASIS MIND AND BODY ” Practice Location

Language	Start Address	Practice Location

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