MEDICARE: HOUSTON ANXIETY AND WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TC0700X	Clinical Psychologist
3	103TC1900X	Counseling Psychologist
4	103T00000X	Psychologist

General Provider Information

NPI Number	:	1467200162
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON ANXIETY AND WELLNESS CENTER

Provider Business Mailing Address
First Line	:	823 KAMANO AVE
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-3293
Country	:	US
Telephone Number	:	832-444-4749
Fax Number	:

Provider Business Practice Location Address
First Line	:	4306 YOAKUM BLVD STE 510
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-5884
Country	:	US
Telephone Number	:	832-444-4749
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND CLINICAL DIRECTOR
Name	:	DR. IVY RUTHS
Credential	:	PHD
Telephone Number	:	832-444-4749

Provider Enumeration Date	:	05/08/2024
Last Update Date	:	05/08/2024

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