Fresh Start Psychiatric Clinic

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

FRESH START PSYCHIATRIC CLINIC

Practice address

11455 Fallbrook Dr Ste 201
Houston, TX 77065-4267

Phone

(337) 223-9487

Fax

(888) 511-5650

NPI assigned

Jul 16, 2020

Organization subpart

No

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

Authorized official

Name

Matthiaus Suire, CNS

Title

Owner

Phone

(512) 952-0295

Specialties & licenses 3

Addresses

Other identifiers 6

Practitioners 1

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

• Charlotte Ivy, LPC

  • Professional Counselor
  • Lafayette, LA
  • NPI 1164013876
  NPD

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

{
    "created_epoch": "1594857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626393600000",
    "number": "1427666353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 DULLES DR",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705062716",
            "telephone_number": "373-223-9487",
            "fax_number": "888-511-5650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11455 FALLBROOK DR STE 201",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770654267",
            "telephone_number": "337-223-9487",
            "fax_number": "888-511-5650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1921 Dulles Dr",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "LA",
            "postal_code": "705062716",
            "country_code": "US",
            "telephone_number": "337-223-9487",
            "fax_number": "888-511-5650",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9843 Blaine Lake Dr",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770862878",
            "country_code": "US",
            "telephone_number": "512-952-0295",
            "fax_number": "888-511-5650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FRESH START PSYCHIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-16",
        "last_updated": "2021-07-16",
        "certification_date": "2021-05-18",
        "status": "A",
        "authorized_official_last_name": "SUIRE",
        "authorized_official_first_name": "MATTHIAUS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "512-952-0295",
        "authorized_official_credential": "CNS"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11813129",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1029807",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "600712760",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS#",
            "identifier": "NJ2611",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "MD.201514",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "418846",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Fresh Therapeutic Group
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• Fresh-N-Clean
• Freshstart Pro

• Multi-Specialty Clinic/Center in Houston, TX
• Providers in Houston, TX by specialty
• Multi-Specialty Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2021; 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.