Active NPI
Marni Elyse Axelrad, PHD
- Psychologist
- Houston, TX
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 32753
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
| License | State | Type | Specialty |
|---|---|---|---|
| PY 6971 | FL | MD | Psychologist |
| 32753 | TX | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Texas Children'S Physician Group | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.