MEDICARE: DR. BECKY SIEKIERSKI PHD, LSSP, NCSP

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	103TC2200X	Clinical Child & Adolescent Psychologist	33696	TX
2	103TS0200X	School Psychologist	31848	TX

General Provider Information

NPI Number	:	1174962476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BECKY SIEKIERSKI PHD, LSSP, NCSP

Provider Business Mailing Address
First Line	:	16815 ROYAL CREST DR STE 160
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2534
Country	:	US
Telephone Number	:	281-407-5658
Fax Number	:	281-407-5631

Provider Business Practice Location Address
First Line	:	16815 ROYAL CREST DR
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77058-2521
Country	:	US
Telephone Number	:	281-407-5658
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	11/17/2014

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