Provider Demographics
NPI:1629372735
Name:INTRACARE BEHAVIORAL HEALTH CLINIC
Entity Type:Organization
Organization Name:INTRACARE BEHAVIORAL HEALTH CLINIC
Other - Org Name:INTRACARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-249-3566
Mailing Address - Street 1:2626 S LOOP W
Mailing Address - Street 2:430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2654
Mailing Address - Country:US
Mailing Address - Phone:713-333-3771
Mailing Address - Fax:713-333-3772
Practice Address - Street 1:2626 S LOOP W
Practice Address - Street 2:430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2654
Practice Address - Country:US
Practice Address - Phone:713-333-3771
Practice Address - Fax:713-333-3772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty