Provider Demographics
NPI:1356657464
Name:GERO-PSYCHIATRIC BEHAVIORAL & MENTAL HEALTH CONSULTANTS
Entity Type:Organization
Organization Name:GERO-PSYCHIATRIC BEHAVIORAL & MENTAL HEALTH CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:VALAIR
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP PMHNP-BC, GNP-BC
Authorized Official - Phone:832-879-2107
Mailing Address - Street 1:201 KINGWOOD MEDICAL DR STE A500
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-6014
Mailing Address - Country:US
Mailing Address - Phone:832-879-2107
Mailing Address - Fax:832-442-5044
Practice Address - Street 1:201 KINGWOOD MEDICAL DR STE A500
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-6014
Practice Address - Country:US
Practice Address - Phone:832-879-2107
Practice Address - Fax:877-495-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty