Provider Demographics
NPI:1932570959
Name:SOUTHEAST TEXAS PSYCHOLOGICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS PSYCHOLOGICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:WEAVER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:409-813-8506
Mailing Address - Street 1:2615 CALDER ST STE 640
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1115
Mailing Address - Country:US
Mailing Address - Phone:337-274-2674
Mailing Address - Fax:214-396-3962
Practice Address - Street 1:2615 CALDER ST STE 640
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1115
Practice Address - Country:US
Practice Address - Phone:337-274-2674
Practice Address - Fax:409-813-8523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36418103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty