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NPI Code Detail

MEDICARE: KETAMINE WELLNESS CENTERS HOUSTON

MEDICARE: KETAMINE WELLNESS CENTERS HOUSTON
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
1207L00000XAnesthesiology Physician
2208VP0000XPain Medicine Physician
3208VP0014XInterventional Pain Medicine Physician
4363A00000XPhysician Assistant
5363L00000XNurse Practitioner
6207LP2900XPain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number : 1861008831
Entity Type Code : Organization
Provider Name (Legal Business Name) : KETAMINE WELLNESS CENTERS HOUSTON
Provider Business Mailing Address
First Line : 12807 HAYNES RD UNIT 1
Second Line :
City : HOUSTON
State : TX
Zip : 77066-1124
Country : US
Telephone Number : 855-538-9355
Fax Number : 844-538-9355
Provider Business Practice Location Address
First Line : 12807 HAYNES RD UNIT 1
Second Line :
City : HOUSTON
State : TX
Zip : 77066-1124
Country : US
Telephone Number : 855-538-9355
Fax Number : 844-538-9355
Authorized Official
Title or Position : EXECUTIVE ASSISTANT
Name : MS. ANITA JERGER
Credential :
Telephone Number : 855-538-9355
Provider Enumeration Date : 09/16/2020
Last Update Date : 08/17/2022

Similar Medicare Providers

1205233830 — HECTOR ALVAREZ LPC
Practice Location Address:
12807 HAYNES RD BLDG C1
HOUSTON, TX
77066-1124
Practice Phone: 346-634-7571
Practice Fax:
1932897048 — BRENDA RESENDEZ MA, LPC
Practice Location Address:
12807 HAYNES RD UNIT C1
HOUSTON, TX
77066-1124
Practice Phone: 281-407-1309
Practice Fax:
1770457541 — LEAH VAN LEUVEN LCSW
Practice Location Address:
12807 HAYNES RD BLDG C1
HOUSTON, TX
77066-1124
Practice Phone: 346-634-7571
Practice Fax:
1386450013 — JON DENNIS SHUFFLER LCSW
Practice Location Address:
12807 HAYNES RD BLDG C1
HOUSTON, TX
77066-1124
Practice Phone: 346-634-7571
Practice Fax:
1386135291 — MRS. CATHY BIRDEN M.ED, LPC
Practice Location Address:
12807 HAYNES RD BLDG C1
HOUSTON, TX
77066-1124
Practice Phone: 713-851-9260
Practice Fax:
1306479985 — KELLIE LOMAS
Practice Location Address:
12807 HAYNES RD BLDG C1
HOUSTON, TX
77066-1124
Practice Phone: 346-634-7571
Practice Fax:

Directions to “KETAMINE WELLNESS CENTERS HOUSTON ” Practice Location

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