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NPI Code Detail

MEDICARE: GERIATRIC EVALUATION & MENTAL

MEDICARE: GERIATRIC EVALUATION & MENTAL
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
1103TC0700XClinical Psychologist

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CJ2516OTHERTXRAILROAD MEDICARE

General Provider Information

NPI Number : 1225208200
Entity Type Code : Organization
Provider Name (Legal Business Name) : GERIATRIC EVALUATION & MENTAL
Provider Business Mailing Address
First Line : 12012 WICKCHESTER LN
Second Line : SUITE 550
City : HOUSTON
State : TX
Zip : 77079-1229
Country : US
Telephone Number : 832-448-2800
Fax Number : 832-448-2801
Provider Business Practice Location Address
First Line : 4501 DUDMAR DR
Second Line :
City : AUSTIN
State : TX
Zip : 78735-6913
Country : US
Telephone Number : 832-448-2800
Fax Number : 832-448-2801
Authorized Official
Title or Position : MANAGER
Name : GARY GERSTENHABER
Credential :
Telephone Number : 512-301-7200
Provider Enumeration Date : 03/06/2008
Last Update Date : 03/17/2008

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Directions to “GERIATRIC EVALUATION & MENTAL ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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