Provider Demographics
NPI:1689928186
Name:TEXAS PSYCHOLOGICAL AND CONSULTATION SERVICES PLLC
Entity Type:Organization
Organization Name:TEXAS PSYCHOLOGICAL AND CONSULTATION SERVICES PLLC
Other - Org Name:TPACS
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-233-6148
Mailing Address - Street 1:21031 MARKET RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2483
Mailing Address - Country:US
Mailing Address - Phone:210-233-6148
Mailing Address - Fax:210-399-8721
Practice Address - Street 1:21031 MARKET RDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-2483
Practice Address - Country:US
Practice Address - Phone:210-233-6148
Practice Address - Fax:210-399-8721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34699103T00000X, 103TC0700X, 103TC2200X
103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310158601Medicaid
TX3101586Medicaid
TX310158602Medicaid
TX261605Medicare PIN