MEDICARE: KEYSTONE MENTAL HEALTH GROUP 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1689529968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEYSTONE MENTAL HEALTH GROUP LLC

Provider Business Mailing Address
First Line	:	510 WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2002
Country	:	US
Telephone Number	:	832-452-9867
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 WAUGH DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-2002
Country	:	US
Telephone Number	:	832-452-9867
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARYBETH ASENIME
Credential	:	PMHNP-BC
Telephone Number	:	832-452-9867

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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