Provider Demographics
NPI:1518930650
Name:DEVEREUX FOUNDATION
Entity Type:Organization
Organization Name:DEVEREUX FOUNDATION
Other - Org Name:DEVEREUX TEXAS TREATMENT NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:HELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-335-1000
Mailing Address - Street 1:1150 DEVEREUX DR
Mailing Address - Street 2:OUTPATIENT CLINIC
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2043
Mailing Address - Country:US
Mailing Address - Phone:281-332-8608
Mailing Address - Fax:281-332-5283
Practice Address - Street 1:1150 DEVEREUX DR
Practice Address - Street 2:OUTPATIENT CLINIC
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2043
Practice Address - Country:US
Practice Address - Phone:281-332-8608
Practice Address - Fax:281-332-5283
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVEREUX FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-09
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTMHP083851801101YA0400X, 101YP2500X, 103T00000X, 106H00000X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083851801Medicaid
TX000718OtherHOSPITAL LICENSE
TX00L82VMedicare PIN