Provider Demographics
NPI:1932322161
Name:PACKWOOD PSYCHOTHERAPY SERVICES
Entity Type:Organization
Organization Name:PACKWOOD PSYCHOTHERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:281-265-7311
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3560
Mailing Address - Country:US
Mailing Address - Phone:281-265-7311
Mailing Address - Fax:281-265-4683
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:281-265-7311
Practice Address - Fax:281-265-4683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U32PMedicare ID - Type Unspecified