Provider Demographics
NPI:1952181224
Name:PSYC MASTERS PLLC
Entity Type:Organization
Organization Name:PSYC MASTERS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF BEHAVIORAL HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:PAOLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORENO-WAZLAVEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:915-487-6828
Mailing Address - Street 1:4900 CATTLE LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79934-2835
Mailing Address - Country:US
Mailing Address - Phone:915-487-6828
Mailing Address - Fax:915-233-2989
Practice Address - Street 1:4900 CATTLE LN
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79934-2835
Practice Address - Country:US
Practice Address - Phone:915-487-6828
Practice Address - Fax:915-233-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty