Provider Demographics
NPI:1770961773
Name:RAINBOW CLINICAL CARE GROUP, PLLC
Entity type:Organization
Organization Name:RAINBOW CLINICAL CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:832-253-5046
Mailing Address - Street 1:PO BOX 1456
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-0037
Mailing Address - Country:US
Mailing Address - Phone:832-253-5046
Mailing Address - Fax:
Practice Address - Street 1:2440 TEXAS PKWY
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77489-4000
Practice Address - Country:US
Practice Address - Phone:832-253-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34929251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health