Provider Demographics
NPI:1649761073
Name:HOUSTON KETAMINE THERAPEUTICS PLLC
Entity Type:Organization
Organization Name:HOUSTON KETAMINE THERAPEUTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASHAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-436-4055
Mailing Address - Street 1:6565 WEST LOOP S STE 530
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:832-436-4055
Mailing Address - Fax:
Practice Address - Street 1:6565 WEST LOOP S STE 530
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3500
Practice Address - Country:US
Practice Address - Phone:832-436-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN94012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty