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1401 Sandia Plz Bryan TX 77802-4356 | |
| (979) 314-9698 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 1401 Sandia Plz, Bryan, Texas |
| Authorized Official Name and Position | Jun-chih Gisela Lin (PSYCHOLOGY OWNER) |
| Authorized Official Contact | 9795756285 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3904 Puffin Way College Station TX 77845-6265 Ph: (979) 575-6285 | 1401 Sandia Plz Bryan TX 77802-4356 Ph: (979) 314-9698 |
| NPI Number | 1407486939 |
|---|---|
| Provider Enumeration Date | 01/23/2020 |
| Last Update Date | 07/15/2020 |
| Certification Date | 07/15/2020 |
| Medicare PECOS PAC ID | 5092145714 |
|---|---|
| Medicare Enrollment ID | O20200421002077 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407486939 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Primary |
| Provider Name | Jun-chih G Lin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1720413321 PECOS PAC ID: 2365664836 Enrollment ID: I20141118000909 |
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