Provider Demographics
NPI:1881650786
Name:CHACKO, REEBA E (MD)
Entity Type:Individual
Prefix:
First Name:REEBA
Middle Name:E
Last Name:CHACKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REEBA
Other - Middle Name:E
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17207 KUYKENDAHL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-8423
Mailing Address - Country:US
Mailing Address - Phone:281-374-8555
Mailing Address - Fax:281-374-8335
Practice Address - Street 1:1502 TAUB LOOP
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-970-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ12502084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166156303Medicaid
TX8K0021OtherBC/BS NUMBER
TX166156301Medicaid
TX166156302Medicaid
TXTXB147532Medicare PIN
TXE38362Medicare UPIN
TX166156302Medicaid