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11025 Voth Rd Beaumont TX 77713-8613 | |
| (800) 257-8715 | |
| (800) 819-1655 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 11025 Voth Rd, Beaumont, Texas |
| Authorized Official Name and Position | Melissa King (DIRECTOR, CREDENTIALING ENROLLMENT) |
| Authorized Official Contact | 8003703651 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
55 Hatchetts Hill Rd Old Lyme CT 06371-1534 Ph: (800) 370-3651 | 11025 Voth Rd Beaumont TX 77713-8613 Ph: (800) 257-8715 |
| NPI Number | 1710935119 |
|---|---|
| Provider Enumeration Date | 05/05/2006 |
| Last Update Date | 07/11/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710935119 | NPI | - | NPPES |
| 136136212 | Medicaid | TX | |
| CB3582 | Other | TX | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Secondary |
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