Provider Demographics
NPI:1407584139
Name:MED O. PSYCHOLOGICAL SERVICES -PLLC
Entity Type:Organization
Organization Name:MED O. PSYCHOLOGICAL SERVICES -PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-519-6998
Mailing Address - Street 1:2440 TEXAS PKWY STE 370K
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-6091
Mailing Address - Country:US
Mailing Address - Phone:281-519-6998
Mailing Address - Fax:
Practice Address - Street 1:2440 TEXAS PKWY STE 370K
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-6091
Practice Address - Country:US
Practice Address - Phone:281-519-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2023-11-21
Deactivation Date:2023-10-27
Deactivation Code:
Reactivation Date:2023-11-21
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1407584139Medicaid