NPIMap

Organization Active NPI

Family Psychiatry

  • Psychiatry Physician
  • Friendswood, TX
National Provider Identifier
1104077031
Registry record updated Jun 26, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
H2742 Issued in TX
Legal business name
FAMILY PSYCHIATRY
Practice address
341 E Parkwood Ave
Friendswood, TX 77546-5147
Phone
(281) 400-3301
Fax
(281) 400-3307
NPI assigned
Oct 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaclyn Burket
Title
Manager
Phone
(281) 400-3301

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Neuroimaging (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084D0003X H2742 TX
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X H2742 TX Primary

Addresses

Primary practice location

341 E Parkwood Ave
Friendswood, TX 77546-5147

Mailing address

PO Box 1808
Friendswood, TX 77549-1808
Phone (281) 400-3301

Other identifiers 1

IdentifierTypeStateIssuer
098513703MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Brain Waves2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245974400000",
    "number": "1104077031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1808",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775491808",
            "telephone_number": "281-400-3301",
            "fax_number": "281-400-3307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "341 E PARKWOOD AVE",
            "city": "FRIENDSWOOD",
            "state": "TX",
            "postal_code": "775465147",
            "telephone_number": "281-400-3301",
            "fax_number": "281-400-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-09",
        "last_updated": "2009-06-26",
        "status": "A",
        "authorized_official_last_name": "BURKET",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "281-400-3301"
    },
    "taxonomies": [
        {
            "code": "2084D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Diagnostic Neuroimaging",
            "state": "TX",
            "license": "H2742",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "H2742",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "098513703",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Friendswood, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.