Provider Demographics
NPI:1073714838
Name:CENTER FOR HEALTH PSYCHOLOGY, PC
Entity Type:Organization
Organization Name:CENTER FOR HEALTH PSYCHOLOGY, PC
Other - Org Name:ACTIONCARE PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARROTT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:915-598-6616
Mailing Address - Street 1:PO BOX 370838
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79937
Mailing Address - Country:US
Mailing Address - Phone:915-598-6616
Mailing Address - Fax:915-598-6651
Practice Address - Street 1:10450 BRIAN MOONEY AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935
Practice Address - Country:US
Practice Address - Phone:915-598-6616
Practice Address - Fax:915-598-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24316103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034403801Medicaid
TX8F22682OtherMEDICARE