Provider Demographics
NPI:1699712638
Name:SENIOR PSYCHOLOGICAL CARE, LLC
Entity type:Organization
Organization Name:SENIOR PSYCHOLOGICAL CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-850-0049
Mailing Address - Street 1:4314 YOAKUM BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5818
Mailing Address - Country:US
Mailing Address - Phone:713-850-0049
Mailing Address - Fax:713-850-0036
Practice Address - Street 1:4314 YOAKUM BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5818
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-850-0036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX178393801Medicaid
TX179841501Medicaid
TX179841501Medicaid
TX00402YMedicare PIN
TX00612YMedicare PIN
TX00403YMedicare UPIN