MEDICARE: INSTITUTE FOR PSYCHOLOGICAL SERVICE

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	101YP2500X	Professional Counselor	17840	TX

General Provider Information

NPI Number	:	1386689032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR PSYCHOLOGICAL SERVICE

Provider Business Mailing Address
First Line	:	1821 OAKDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5934
Country	:	US
Telephone Number	:	713-521-7040
Fax Number	:	713-521-7042

Provider Business Practice Location Address
First Line	:	1821 OAKDALE ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-5934
Country	:	US
Telephone Number	:	713-521-7040
Fax Number	:	713-521-7042

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. WILLIE MAE LEWIS
Credential	:	PH.D
Telephone Number	:	713-521-7040

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	08/22/2020

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Directions to “INSTITUTE FOR PSYCHOLOGICAL SERVICE ” Practice Location

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