Provider Demographics
NPI:1861438764
Name:ADULT & CHILD PSYCHIATRIC CLINIC
Entity type:Organization
Organization Name:ADULT & CHILD PSYCHIATRIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:CRESS
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:281-286-0110
Mailing Address - Street 1:17625 EL CAMINO REAL
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3085
Mailing Address - Country:US
Mailing Address - Phone:281-286-0110
Mailing Address - Fax:282-860-0411
Practice Address - Street 1:17625 EL CAMINO REAL
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-3052
Practice Address - Country:US
Practice Address - Phone:281-286-0110
Practice Address - Fax:282-860-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty