Individual provider Active NPI

Marni Elyse Axelrad, PHD

  • Psychologist
  • Houston, TX
National Provider Identifier
1487708152
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
32753 Issued in TX
Practice address
6621 Fannin St
CCC 1630.00
Houston, TX 77030-2303
Phone
(832) 822-3700
Fax
(832) 825-4164
NPI assigned
Jan 22, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PY 6971 FL
Psychologist 103T00000X 32753 TX Primary

Addresses

Primary practice location

6621 Fannin St
CCC 1630.00
Houston, TX 77030-2303

Mailing address

6621 Fannin St
CCC 1630.00
Houston, TX 77030-2303
Phone (832) 822-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090925000109 TX Practitioner - Clinical Psychologist 3476609983 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PY 6971FLMDPsychologist
32753TXMDPediatric Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Children'S Physician Group CurrentSince Oct 1, 2009 Accepting new patients

Locations

6621 Fannin St
Ste 1630
Houston, TX 77030

6701 Fannin St
Ste 1630
Houston, TX 77030
Phone (832) 822-3700

6621 Fannin St
#163000
Houston, TX 77030
Phone (832) 822-3700

6621 Fannin St
Houston, TX 77030
Phone (832) 824-1866

6701 Fannin St
Ste 1420
Houston, TX 77030
Phone (832) 822-4240

6701 Fannin St
Houston, TX 77030
Phone (832) 822-1764

101 W Expressway 83
McAllen, TX 78503
Phone (956) 661-9840

17600 Interstate 45 S
The Woodlands, TX 77384
Phone (936) 267-5000

6651 Main St
Va Hospital, TX 77030
Phone (832) 826-3000

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487708152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6621 FANNIN ST",
            "address_2": "CCC 1630.00",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302303",
            "telephone_number": "832-822-3700",
            "fax_number": "832-825-4164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6621 FANNIN ST",
            "address_2": "CCC 1630.00",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770302303",
            "telephone_number": "832-822-3700",
            "fax_number": "832-825-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AXELRAD",
        "first_name": "MARNI",
        "middle_name": "ELYSE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "FL",
            "license": "PY 6971",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "32753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.