MEDICARE: DR. JACKLIN G TAWADROUS PHD, LP

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	103T00000X	Psychologist	37396	TX

General Provider Information

NPI Number	:	1730493479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKLIN G TAWADROUS PHD, LP

Provider Business Mailing Address
First Line	:	16441 SPACE CENTER BLVD # C-100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2015
Country	:	US
Telephone Number	:	281-480-7554
Fax Number	:	281-480-4193

Provider Business Practice Location Address
First Line	:	16441 SPACE CENTER BLVD # C-100
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-2015
Country	:	US
Telephone Number	:	281-480-7554
Fax Number	:	281-480-4193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	02/05/2024

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