MEDICARE: TIS-THERAPEUTIC INTERVENTION SERVICES

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	273R00000X	Psychiatric Hospital Unit	36199	TX

General Provider Information

NPI Number	:	1194953737
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIS-THERAPEUTIC INTERVENTION SERVICES

Provider Business Mailing Address
First Line	:	6715 SEINFELD CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1725
Country	:	US
Telephone Number	:	281-580-9090
Fax Number	:	281-893-1650

Provider Business Practice Location Address
First Line	:	6715 SEINFELD CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77069-1725
Country	:	US
Telephone Number	:	281-580-9090
Fax Number	:	281-893-1650

Authorized Official
Title or Position	:	OWNER/LEAD THERAPIST
Name	:	JOSEPH GEORGE NEIFERT
Credential	:	LCSW-BOARD APP SUPER
Telephone Number	:	281-580-9090

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	03/20/2010

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