| Med O. Psychological Services -pllc | |
|
2440 Texas Pkwy Ste 370k Missouri City TX 77489-6091 | |
| (281) 519-6998 | |
| Not Available |
| Full Name | Med O. Psychological Services -pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2440 Texas Pkwy Ste 370k, Missouri City, Texas |
| Authorized Official Name and Position | William Goldsmith (PRESIDENT) |
| Authorized Official Contact | 2815196998 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Med O. Psychological Services -pllc 2440 Texas Pkwy Ste 370k Missouri City TX 77489-6091 Ph: (281) 519-6998 | Med O. Psychological Services -pllc 2440 Texas Pkwy Ste 370k Missouri City TX 77489-6091 Ph: (281) 519-6998 |
| NPI Number | 1407584139 |
|---|---|
| Provider Enumeration Date | 08/10/2022 |
| Last Update Date | 11/21/2023 |
| Certification Date | 08/24/2022 |
| Medicare PECOS PAC ID | 9537544556 |
|---|---|
| Medicare Enrollment ID | O20220912002514 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407584139 | NPI | - | NPPES |
| 1407584139 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Sereathia Kesee |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851698617 PECOS PAC ID: 1951532985 Enrollment ID: I20140315000098 |
| Provider Name | Heidi Rose Mandl |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851746499 PECOS PAC ID: 7719276542 Enrollment ID: I20160518002062 |
| Provider Name | Lashan Archie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770286536 PECOS PAC ID: 2163889288 Enrollment ID: I20230606000964 |
| Provider Name | Maleeta Ayresce Watson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396441739 PECOS PAC ID: 0749649184 Enrollment ID: I20230703003165 |
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