Provider Demographics
NPI:1841208931
Name:PATELIS, ATHENA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:
Last Name:PATELIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 SPACE CENTER BLVD, SUITE C-100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058
Mailing Address - Country:US
Mailing Address - Phone:281-480-7554
Mailing Address - Fax:281-480-4641
Practice Address - Street 1:16441 SPACE CENTER BLVD # C100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2015
Practice Address - Country:US
Practice Address - Phone:281-480-7554
Practice Address - Fax:281-480-4641
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86406AOtherBCBS OF TX
TX1689690083OtherMEDICARE
TX319968YVY8OtherMEDICARE (UNDER KRIST SAMARITAN COUNSELING)
TX00583EOtherMEDICARE
TX175072671OtherMEDICARE