Provider Demographics
NPI:1295917458
Name:THE EDD CLINIC FOR PSYCHOTHERAPY AND COUNSELING
Entity type:Organization
Organization Name:THE EDD CLINIC FOR PSYCHOTHERAPY AND COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:EDD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:281-558-6231
Mailing Address - Street 1:11767 KATY FWY
Mailing Address - Street 2:SUITE 715
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1716
Mailing Address - Country:US
Mailing Address - Phone:281-558-6231
Mailing Address - Fax:281-558-6379
Practice Address - Street 1:11767 KATY FWY
Practice Address - Street 2:SUITE 715
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1716
Practice Address - Country:US
Practice Address - Phone:281-558-6231
Practice Address - Fax:281-558-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23060103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085604901Medicaid
TX00U26MMedicare UPIN