| Envision Mindcare Of Texas Llc | |
|
12930 Dairy Ashford Rd Ste 103 Sugar Land TX 77478-4666 | |
| (832) 626-5192 | |
| (832) 310-1158 |
| Full Name | Envision Mindcare Of Texas Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 12930 Dairy Ashford Rd Ste 103, Sugar Land, Texas |
| Authorized Official Name and Position | Randy Warner (OWNER) |
| Authorized Official Contact | 8326265192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Envision Mindcare Of Texas Llc 12930 Dairy Ashford Rd Ste 103 Sugar Land TX 77478-4666 Ph: (832) 626-5192 | Envision Mindcare Of Texas Llc 12930 Dairy Ashford Rd Ste 103 Sugar Land TX 77478-4666 Ph: (832) 626-5192 |
| NPI Number | 1487419404 |
|---|---|
| Provider Enumeration Date | 02/19/2024 |
| Last Update Date | 05/23/2024 |
| Certification Date | 05/23/2024 |
| Medicare PECOS PAC ID | 0941648117 |
|---|---|
| Medicare Enrollment ID | O20240406000461 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487419404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Randy Warner |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1144380056 PECOS PAC ID: 5294712279 Enrollment ID: I20240406000474 |
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