MEDICARE: TEXAS BRAIN INSTITUTE LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1679152607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS BRAIN INSTITUTE LLC

Provider Business Mailing Address
First Line	:	6808 HORNWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77074-3608
Country	:	US
Telephone Number	:	888-900-1824
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 FANNIN ST STE 110B
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5000
Country	:	US
Telephone Number	:	888-900-1824
Fax Number	:	713-779-3400

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. STEFANIE VELGOS
Credential	:	PHD, M.SC
Telephone Number	:	888-900-1824

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	02/12/2024

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