MEDICARE: BEACON BEHAVIORAL OF TEXAS PA

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

General Provider Information

NPI Number	:	1205655883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACON BEHAVIORAL OF TEXAS PA

Provider Business Mailing Address
First Line	:	5959 WEST LOOP S STE 600
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2425
Country	:	US
Telephone Number	:	713-669-0303
Fax Number	:

Provider Business Practice Location Address
First Line	:	5959 WEST LOOP S STE 600
Second Line	:
City	:	BELLAIRE
State	:	TX
Zip	:	77401-2425
Country	:	US
Telephone Number	:	713-669-0303
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	KIMBERLY GLAVESKAS
Credential	:
Telephone Number	:	214-550-7536

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	04/09/2026

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