Provider Demographics
NPI:1619361748
Name:THE MENNINGER CLINIC
Entity Type:Organization
Organization Name:THE MENNINGER CLINIC
Other - Org Name:OUTPATIENT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR FOR OUTPATIENT SV
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:713-275-5319
Mailing Address - Street 1:12301 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-6207
Mailing Address - Country:US
Mailing Address - Phone:713-275-5000
Mailing Address - Fax:713-275-5120
Practice Address - Street 1:12301 MAIN ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-6207
Practice Address - Country:US
Practice Address - Phone:713-275-5000
Practice Address - Fax:713-275-5120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MENNINGER CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100144261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)