Provider Demographics
NPI:1720261811
Name:ADONAI PSYCHOLOGICAL SERVICES, PA
Entity Type:Organization
Organization Name:ADONAI PSYCHOLOGICAL SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SCHLONEGER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:281-651-1700
Mailing Address - Street 1:20615 NANNETTE LN
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4824
Mailing Address - Country:US
Mailing Address - Phone:281-651-1700
Mailing Address - Fax:281-651-1775
Practice Address - Street 1:20615 NANNETTE LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4824
Practice Address - Country:US
Practice Address - Phone:281-651-1700
Practice Address - Fax:281-651-1775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30820103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y538OtherMEDICARE GROUP PTAN
TX140937702Medicaid
TX8F7015OtherMEDICARE INDIVIDUAL PTAN