MEDICARE: PROPSYCH MANAGEMENT, INC.

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1487686267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROPSYCH MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	5450 NW CENTRAL DR
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77092-2017
Country	:	US
Telephone Number	:	713-934-8121
Fax Number	:

Provider Business Practice Location Address
First Line	:	5450 NW CENTRAL DR
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77092-2017
Country	:	US
Telephone Number	:	713-934-8121
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. LESLIE WADE KING
Credential	:
Telephone Number	:	713-934-8121

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	08/22/2020

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