MEDICARE: STARBRANCH PSYCHIATRY ASSOCIATES

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	2084P0015X	Psychosomatic Medicine Physician	E3150	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0026BY	OTHER	TX	BLUE CROSS

General Provider Information

NPI Number	:	1205053022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STARBRANCH PSYCHIATRY ASSOCIATES

Provider Business Mailing Address
First Line	:	2600 GESSNER DR
Second Line	:	SUITE 280
City	:	HOUSTON
State	:	TX
Zip	:	77080-3839
Country	:	US
Telephone Number	:	713-490-7017
Fax Number	:	281-577-1105

Provider Business Practice Location Address
First Line	:	2600 GESSNER DR
Second Line	:	SUITE 280
City	:	HOUSTON
State	:	TX
Zip	:	77080-3839
Country	:	US
Telephone Number	:	713-490-7017
Fax Number	:	281-577-1105

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. EILEEN K STARBRANCH
Credential	:	M.D.
Telephone Number	:	713-490-7017

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	04/02/2008

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