1174768295 NPI number — DR. TERESA LEAH TARVER PSYD

Table of content: DR. TERESA LEAH TARVER PSYD (NPI 1174768295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174768295 NPI number — DR. TERESA LEAH TARVER PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARVER
Provider First Name:
TERESA
Provider Middle Name:
LEAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
F

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:
1174768295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15201 MASON RD STE 1000
Provider Second Line Business Mailing Address:
PMB 133
Provider Business Mailing Address City Name:
CYPRESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77433-5977
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11811 FM 1960 RD W
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77065-3827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-943-9250
Provider Business Practice Location Address Fax Number:
281-894-0101
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  33770 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 33770 . This is a "PSYD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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