MEDICARE: ADULT & CHILD PSYCHIATRIC CLINIC

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	101YM0800X	Mental Health Counselor	14761	TX

General Provider Information

NPI Number	:	1861438764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & CHILD PSYCHIATRIC CLINIC

Provider Business Mailing Address
First Line	:	17625 EL CAMINO REAL
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77058-3085
Country	:	US
Telephone Number	:	281-286-0110
Fax Number	:	282-860-0411

Provider Business Practice Location Address
First Line	:	17625 EL CAMINO REAL
Second Line	:	SUITE 160
City	:	HOUSTON
State	:	TX
Zip	:	77058-3052
Country	:	US
Telephone Number	:	281-286-0110
Fax Number	:	282-860-0411

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	MRS. CANDY CRESS DECKER
Credential	:	MA, LPC
Telephone Number	:	281-286-0110

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	06/16/2008

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