Provider Demographics
NPI:1053522219
Name:MEDPSYCH
Entity type:Organization
Organization Name:MEDPSYCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRECIOUS
Authorized Official - Middle Name:N
Authorized Official - Last Name:DESHIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-578-2416
Mailing Address - Street 1:3630 WINDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-6132
Mailing Address - Country:US
Mailing Address - Phone:281-578-2416
Mailing Address - Fax:281-646-8195
Practice Address - Street 1:3630 WINDLEWOOD DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-6132
Practice Address - Country:US
Practice Address - Phone:281-578-2416
Practice Address - Fax:281-646-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX011330251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011330OtherHOME HEALTH CARE