Provider Demographics
NPI:1700591492
Name:LYNX HEALTHCARE & PSYCHIATRY
Entity Type:Organization
Organization Name:LYNX HEALTHCARE & PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:OUTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,MSN,DNP
Authorized Official - Phone:713-498-2112
Mailing Address - Street 1:PO BOX 667603
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77266-7603
Mailing Address - Country:US
Mailing Address - Phone:713-498-2112
Mailing Address - Fax:281-201-1600
Practice Address - Street 1:480 N SAM HOUSTON PKWY E STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3567
Practice Address - Country:US
Practice Address - Phone:281-741-8063
Practice Address - Fax:346-299-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1295745289OtherNPI