Provider Demographics
NPI:1093136152
Name:CONNECT PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:CONNECT PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LSSP, BCBA-D
Authorized Official - Phone:832-534-3993
Mailing Address - Street 1:26205 OAK RIDGE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-1916
Mailing Address - Country:US
Mailing Address - Phone:832-534-3993
Mailing Address - Fax:281-292-2365
Practice Address - Street 1:26205 OAK RIDGE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380-1916
Practice Address - Country:US
Practice Address - Phone:832-534-3993
Practice Address - Fax:281-292-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10361103K00000X
TX32280103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty