Provider Demographics
NPI:1518269802
Name:PSYCHIATRIC SERVICES ROGER HOUSE, M.D.
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES ROGER HOUSE, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSE
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:903-792-4779
Mailing Address - Street 1:2401 SUMMERHILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3570
Mailing Address - Country:US
Mailing Address - Phone:903-792-4779
Mailing Address - Fax:903-792-4693
Practice Address - Street 1:2401 SUMMERHILL RD STE A
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-3570
Practice Address - Country:US
Practice Address - Phone:903-792-4779
Practice Address - Fax:903-792-4693
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PSYCHIATRIC SERVICES ROGER HOUSE, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67139101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115325604Medicaid
TXC68543Medicare UPIN