Provider Demographics
NPI:1063716785
Name:DSG CLINICAL SERVICES PLLC
Entity type:Organization
Organization Name:DSG CLINICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:GENAC
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:713-899-3769
Mailing Address - Street 1:1712 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1967
Mailing Address - Country:US
Mailing Address - Phone:713-899-3769
Mailing Address - Fax:
Practice Address - Street 1:1712 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1967
Practice Address - Country:US
Practice Address - Phone:713-899-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31528103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211680801Medicaid
TX211680802Medicaid
TX211680802Medicaid