| Psych Health | |
|
301 East Division Street Greenville TX 75402-4199 | |
| (903) 454-6000 | |
| Not Available |
| Full Name | Psych Health |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 301 East Division Street, Greenville, Texas |
| Authorized Official Name and Position | Micky Keyurnath Gautam (OWNER/PRESIDENT) |
| Authorized Official Contact | 9037830864 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Psych Health Po Box 853072 Richardson TX 75085-3072 Ph: (903) 783-0864 | Psych Health 301 East Division Street Greenville TX 75402-4199 Ph: (903) 454-6000 |
| NPI Number | 1679719751 |
|---|---|
| Provider Enumeration Date | 12/19/2008 |
| Last Update Date | 09/17/2012 |
| Medicare PECOS PAC ID | 4688821283 |
|---|---|
| Medicare Enrollment ID | O20120905000206 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679719751 | NPI | - | NPPES |
| L1861 | Other | TX | TX LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | L1861 (Texas) | Primary |
| Provider Name | Micky Gautam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1518067602 PECOS PAC ID: 5496842643 Enrollment ID: I20071109000237 |
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