Provider Demographics
NPI:1194373555
Name:CHAMPAGNE PSYCHIATRY PLLC
Entity Type:Organization
Organization Name:CHAMPAGNE PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-475-4428
Mailing Address - Street 1:10857 KUYKENDAHL RD STE 210
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2936
Mailing Address - Country:US
Mailing Address - Phone:281-475-4428
Mailing Address - Fax:281-619-7042
Practice Address - Street 1:10857 KUYKENDAHL RD STE 210
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77382-2936
Practice Address - Country:US
Practice Address - Phone:281-475-4428
Practice Address - Fax:281-619-7042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty