Provider Demographics
NPI:1760432421
Name:PSYCHIATRIC SERVICES OF HOUSTON
Entity Type:Organization
Organization Name:PSYCHIATRIC SERVICES OF HOUSTON
Other - Org Name:SENIOR PSYCHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-850-0120
Mailing Address - Street 1:4150 WESTHEIMER RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4414
Mailing Address - Country:US
Mailing Address - Phone:713-850-0120
Mailing Address - Fax:713-850-0036
Practice Address - Street 1:4150 WESTHEIMER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4414
Practice Address - Country:US
Practice Address - Phone:713-850-0120
Practice Address - Fax:713-850-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8507103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00622RMedicare ID - Type UnspecifiedRURAL CTY SPC
TX00621RMedicare ID - Type UnspecifiedGALVESTON CTY SPC
TX00620RMedicare ID - Type UnspecifiedHARRIS CTY SPC
TXC13626Medicare UPIN