| Tabula Rasa Psychology, Pllc | |
|
2636 S Loop W #550-a Houston TX 77054 | |
| (432) 698-0141 | |
| (281) 605-6722 |
| Full Name | Tabula Rasa Psychology, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 2636 S Loop W #550-a, Houston, Texas |
| Authorized Official Name and Position | Blythe Twosisters (MANAGER/OWNER) |
| Authorized Official Contact | 2149974697 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tabula Rasa Psychology, Pllc 2636 S Loop W #550-a Houston TX 77054 Ph: (432) 698-0141 | Tabula Rasa Psychology, Pllc 2636 S Loop W #550-a Houston TX 77054 Ph: (432) 698-0141 |
| NPI Number | 1477066512 |
|---|---|
| Provider Enumeration Date | 11/12/2017 |
| Last Update Date | 08/22/2024 |
| Certification Date | 07/17/2024 |
| Medicare PECOS PAC ID | 5193150068 |
|---|---|
| Medicare Enrollment ID | O20200123000166 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477066512 | NPI | - | NPPES |
| 4067100 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 103TC0700X | Psychologist - Clinical | 36566 (Texas) | Primary |
| Provider Name | Blythe Twosisters |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1497191902 PECOS PAC ID: 6002241973 Enrollment ID: I20200123000236 |
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