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305 Londonderry Dr Suite 10 Waco TX 76712-7929 | |
| (254) 732-0591 | |
| (254) 732-0595 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 305 Londonderry Dr, Waco, Texas |
| Authorized Official Name and Position | Jason Boley (PRESIDENT) |
| Authorized Official Contact | 2547320591 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
305 Londonderry Dr Suite 10 Waco TX 76712-7929 Ph: (254) 732-0591 | 305 Londonderry Dr Suite 10 Waco TX 76712-7929 Ph: (254) 732-0591 |
| NPI Number | 1285974865 |
|---|---|
| Provider Enumeration Date | 02/19/2013 |
| Last Update Date | 02/19/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285974865 | NPI | - | NPPES |
| 1134185234 | Other | TX | NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | M0668 (Texas) | Primary |
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