MEDICARE: BLUEBONNET FAMILY PSYCHIATRY

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	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1588484315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUEBONNET FAMILY PSYCHIATRY

Provider Business Mailing Address
First Line	:	1300 N SAM HOUSTON PKWY E STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-2962
Country	:	US
Telephone Number	:	832-310-8014
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 N SAM HOUSTON PKWY E STE 230
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-2962
Country	:	US
Telephone Number	:	832-310-8014
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HUMERA DANWAR
Credential	:	MD
Telephone Number	:	832-310-8014

Provider Enumeration Date	:	10/16/2024
Last Update Date	:	10/16/2024

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