Provider Demographics
NPI:1700926805
Name:MEDICAL PSYCHOLOGY ASSOCIATES, PC
Entity Type:Organization
Organization Name:MEDICAL PSYCHOLOGY ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:281-218-8181
Mailing Address - Street 1:1560 W BAY AREA BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2674
Mailing Address - Country:US
Mailing Address - Phone:281-218-8181
Mailing Address - Fax:281-218-7676
Practice Address - Street 1:1560 W BAY AREA BLVD STE 305
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-2674
Practice Address - Country:US
Practice Address - Phone:281-218-8181
Practice Address - Fax:281-218-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23556103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680014828OtherPALMETTO GBA
TX093993601Medicaid
TXDO9449OtherPALMETTO GBA
TXDO9449OtherPALMETTO GBA
TXOOH36EMedicare ID - Type Unspecified