1548139264 NPI number — INSTITUE FOR PSYCHOLOGICAL SERVICE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548139264 NPI number — INSTITUE FOR PSYCHOLOGICAL SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSTITUE FOR PSYCHOLOGICAL SERVICE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548139264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3302 CHARLESTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77021-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-407-3190
Provider Business Mailing Address Fax Number:
713-440-7714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 EMANCIPATION AVE STE 290
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77004-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-407-3190
Provider Business Practice Location Address Fax Number:
713-440-7714
Provider Enumeration Date:
10/31/2025

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
WILLIE
Authorized Official Middle Name:
MAE
Authorized Official Title or Position:
PH.D.
Authorized Official Telephone Number:
281-381-2276

Provider Taxonomy Codes

  • Taxonomy code: 103TB0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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