Provider Demographics
NPI:1003833195
Name:BEAUMONT PSYCHOLOGICAL SERVICES PC
Entity Type:Organization
Organization Name:BEAUMONT PSYCHOLOGICAL SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:KAIMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-3244
Mailing Address - Street 1:3560 DELAWARE ST
Mailing Address - Street 2:SUITE107
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3059
Mailing Address - Country:US
Mailing Address - Phone:409-899-3244
Mailing Address - Fax:409-898-3153
Practice Address - Street 1:3560 DELAWARE ST
Practice Address - Street 2:SUITE107
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3059
Practice Address - Country:US
Practice Address - Phone:409-899-3244
Practice Address - Fax:409-898-3153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0022GDOtherBLUE CROSS BLUE SHIELD
TX00W871Medicare PIN