Provider Demographics
NPI:1093303018
Name:CLEAR LAKE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:CLEAR LAKE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-774-1062
Mailing Address - Street 1:1110 NASA PKWY STE 545Q
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3393
Mailing Address - Country:US
Mailing Address - Phone:832-261-1432
Mailing Address - Fax:
Practice Address - Street 1:1110 NASA PKWY STE 545Q
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3393
Practice Address - Country:US
Practice Address - Phone:832-261-1432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty