MEDICARE: VEAZEY PSYCHOLOGICAL SERVICE, PLLC

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	103TC0700X	Clinical Psychologist	36025	TX

General Provider Information

NPI Number	:	1861744245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEAZEY PSYCHOLOGICAL SERVICE, PLLC

Provider Business Mailing Address
First Line	:	21903 VENTURE PARK DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5202
Country	:	US
Telephone Number	:	832-595-4641
Fax Number	:

Provider Business Practice Location Address
First Line	:	21903 VENTURE PARK DR
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77406-5202
Country	:	US
Telephone Number	:	832-595-4641
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST- OWNER
Name	:	CONNIE VEAZEY
Credential	:	PHD
Telephone Number	:	832-595-4641

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	07/05/2016

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