Psychology Care Associates PLLC
Organization Active NPI Clinical Psychologist · Roanoke, TX
NPI 1356898282 · NPPES record last updated Sep 8, 2016
Key facts
- NPI
- 1356898282
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 36929 (TX)
- Legal business name
- PSYCHOLOGY CARE ASSOCIATES PLLC
- Practice address
- 209 Travis St
Suite 102
Roanoke, TX 76262-8603 - Phone
- (817) 437-4505
- NPI assigned
- Sep 8, 2016
- Organization subpart
- No
Authorized official
- Name
- Elena Riedo, LCP
- Title
- Owner
- Phone
- (817) 437-4505
Practitioners 6
-
Elena Riedo, PSY.D.
-
Richard K Sohn, PSY.D.
-
Twila Engeman, PHD
-
Cara Cobos Guziak, MS, LPC, NCC, BCN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170426000294 | TX | Part B Supplier - Clinic/Group Practice | 3971880105 |
Receives reassigned benefits from 3 practitioners Practice locations: Roanoke, TX |
National Provider Directory
Locations
209 Travis St
Ste 102
Roanoke, TX 76262
Phone (817) 437-4505
1723 E Southlake Blvd
Ste 120
Southlake, TX 76092
Phone (817) 437-4505
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | 36929 | TX | Yes |
Addresses
Primary practice location
209 Travis St
Suite 102
Roanoke, TX 76262-8603
Mailing address
209 Travis St
Suite 102
Roanoke, TX 76262-8603
Phone (817) 437-4505
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.