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3411 Cedar Knolls Dr Ste B Kingwood TX 77339-2474 | |
| (281) 532-5462 | |
| (877) 796-5317 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3411 Cedar Knolls Dr Ste B, Kingwood, Texas |
| Authorized Official Name and Position | Bharath Gururaj Raj (MANAGING MEMBER) |
| Authorized Official Contact | 8324104602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3411 Cedar Knolls Dr Ste B Kingwood TX 77339-2474 Ph: (281) 532-5462 | 3411 Cedar Knolls Dr Ste B Kingwood TX 77339-2474 Ph: (281) 532-5462 |
| NPI Number | 1386098283 |
|---|---|
| Provider Enumeration Date | 04/17/2016 |
| Last Update Date | 11/02/2020 |
| Certification Date | 11/02/2020 |
| Medicare PECOS PAC ID | 6002101839 |
|---|---|
| Medicare Enrollment ID | O20160818000959 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386098283 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0805X | Psychiatry & Neurology - Geriatric Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Bharath G Raj |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780840587 PECOS PAC ID: 9830240704 Enrollment ID: I20090706000651 |
| Provider Name | Carla L Heinly |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720343858 PECOS PAC ID: 2264787266 Enrollment ID: I20180614002968 |
| Provider Name | Victor Bonoan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386300267 PECOS PAC ID: 1951793173 Enrollment ID: I20220120002650 |
| Provider Name | Nancy M Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053913392 PECOS PAC ID: 0345625463 Enrollment ID: I20220909002054 |
| Provider Name | Vincent Bett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285320655 PECOS PAC ID: 1951752195 Enrollment ID: I20240111003444 |
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