Provider Demographics
NPI:1194187849
Name:PSYCHIATRIC SPECIALISTS OF TEXAS, PLLC
Entity Type:Organization
Organization Name:PSYCHIATRIC SPECIALISTS OF TEXAS, PLLC
Other - Org Name:CHILDREN'S PSYCHIATRIC SERVICES OF SOUTH TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:KOEPSEL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:361-452-1151
Mailing Address - Street 1:5440 OLD BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78417
Mailing Address - Country:US
Mailing Address - Phone:361-452-1151
Mailing Address - Fax:361-452-1517
Practice Address - Street 1:5440 OLD BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78417
Practice Address - Country:US
Practice Address - Phone:361-452-1151
Practice Address - Fax:361-452-1517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232350363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196911502Medicaid