Provider Demographics
NPI:1053095075
Name:MULTICULTURAL BEHAVIORAL HEALTH OF TEXAS
Entity type:Organization
Organization Name:MULTICULTURAL BEHAVIORAL HEALTH OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GHIAN
Authorized Official - Middle Name:FHILLIPE
Authorized Official - Last Name:PIERALDI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:864-516-9619
Mailing Address - Street 1:8101 SHIN OAK DR APT 6116
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2479
Mailing Address - Country:US
Mailing Address - Phone:864-516-9619
Mailing Address - Fax:
Practice Address - Street 1:8101 SHIN OAK DR APT 6116
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2479
Practice Address - Country:US
Practice Address - Phone:864-516-9619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15085112997Medicaid