| Larery-dvali Psychological Services Pc | |
|
52 Sugar Creek Center Blvd Ste. 300 Sugar Land TX 77478-2206 | |
| (713) 900-5557 | |
| (713) 900-5557 |
| Full Name | Larery-dvali Psychological Services Pc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 52 Sugar Creek Center Blvd, Sugar Land, Texas |
| Authorized Official Name and Position | Angela Larery (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8327947513 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Larery-dvali Psychological Services Pc 52 Sugar Creek Center Blvd Ste. 300 Sugar Land TX 77478-2206 Ph: (713) 900-5557 | Larery-dvali Psychological Services Pc 52 Sugar Creek Center Blvd Ste. 300 Sugar Land TX 77478-2206 Ph: (713) 900-5557 |
| NPI Number | 1730568817 |
|---|---|
| Provider Enumeration Date | 05/22/2015 |
| Last Update Date | 03/03/2017 |
| Medicare PECOS PAC ID | 8022380559 |
|---|---|
| Medicare Enrollment ID | O20170818000253 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730568817 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 34051 (Texas) | Primary |
| 103TC0700X | Psychologist - Clinical | 34051 (Texas) | Secondary |
| Provider Name | Angela R Larery |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1992934483 PECOS PAC ID: 7315083599 Enrollment ID: I20090930000750 |
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