Tabula Rasa Psychology, PLLC
Organization Active NPI Clinical Psychologist · Houston, TX
NPI 1477066512 · NPPES record last updated Aug 22, 2024
Key facts
- NPI
- 1477066512
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 36566 (TX)
- Legal business name
- TABULA RASA PSYCHOLOGY, PLLC
- Practice address
- 2636 S Loop W #550-a
Houston, TX 77054 - Phone
- (432) 698-0141
- Fax
- (281) 605-6722
- NPI assigned
- Nov 12, 2017
- Organization subpart
- No
Authorized official
- Name
- Dr. Blythe Twosisters, PSYD
- Title
- Manager/Owner
- Phone
- (214) 997-4697
Practitioners 4
-
Blythe Twosisters, PSY.D.
-
Tierra Lashawn Ledet, M.ED., LPA-IP
-
George Scott III, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200123000166 | TX | Part B Supplier - Clinic/Group Practice | 5193150068 |
Receives reassigned benefits from 1 practitioner Practice locations: Houston, TX |
National Provider Directory
Locations
2636 S Loop W
#550A
Houston, TX 77054
Phone (432) 698-0141
2636 S Loop W
Ste 550A
Houston, TX 77054
Phone (432) 698-0141
5445 Almeda Rd
#407
Houston, TX 77004
2339 Commerce St
Ste 135
Houston, TX 77002
Phone (432) 698-0141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist |
103T00000X | |||
| Clinical Psychologist |
103TC0700X | 36566 | TX | Yes |
Addresses
Primary practice location
2636 S Loop W #550-a
Houston, TX 77054
Mailing address
2636 S Loop W #550-a
Houston, TX 77054
Phone (432) 698-0141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4067100 | Medicaid | TX |
Other providers in Houston, TX
- Jenna Alessa Maria Manilay Tabien
- Tabono Counseling and Mediation Center, LLC
- Tabor Smith D.C. P.a.
- Debra Diane Tabor
- Zachary Tabrani
- Florante T Tabula
- Phyllis J. Tacchi
- Susan Dixon Tacchi
- Kenneth Lee Tackett
- Tacori Inc
All providers in Houston, TX · Clinical Psychologist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2024. 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.