NPIMap

Organization Active NPI

Beacon Behavioral of Texas PA

Doing business as Memorial Park Psychiatry

  • Psychiatry Physician
  • Houston, TX
National Provider Identifier
1114762382
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
BEACON BEHAVIORAL OF TEXAS PA
Doing business as
Memorial Park Psychiatry
Practice address
550 Westcott St Ste 520
Houston, TX 77007-9001
Phone
(713) 864-6694
NPI assigned
Jun 28, 2024
Last updated
Jun 28, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BEACON BEHAVIORAL OF TEXAS PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Kimberly Glaveskas
Title
Credentialing Supervisor
Phone
(443) 962-3945

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

550 Westcott St Ste 520
Houston, TX 77007-9001

Mailing address

550 Westcott St Ste 520
Houston, TX 77007-9001
Phone (713) 864-6694

Other names 1

  • Memorial Park Psychiatry Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Beacon Behavioral of TX PA7 organizations share this tax ID, including this one
Part of
Beacon Behavioral of TX PA

Other organizations with this tax ID 6

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1114762382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 WESTCOTT ST STE 520",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770079001",
            "telephone_number": "713-864-6694",
            "fax_number": "713-864-6698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 WESTCOTT ST STE 520",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770079001",
            "telephone_number": "713-864-6694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON BEHAVIORAL OF TEXAS PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BEACON BEHAVIORAL OF TEXAS PA",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-24",
        "status": "A",
        "authorized_official_last_name": "GLAVESKAS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "443-962-3945"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Park Psychiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.