Active NPI
Renee Lee Sides, MA, LSSP
- School Psychologist
- Coldspring, TX
National Provider Identifier
1497355358
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 30497
- Practice address
- 14210 TX-150
Coldspring, TX 77331 - Phone
- (936) 653-1179
- NPI assigned
- Oct 29, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 30497 | TX | Primary |
Addresses
Primary practice location
14210 TX-150
Coldspring, TX 77331
Mailing address
160 Boys Camp Rd
New Waverly, TX 77358-5870
Phone (936) 777-5630
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30497 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1603929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633046400000",
"number": "1497355358",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 BOYS CAMP RD",
"city": "NEW WAVERLY",
"state": "TX",
"postal_code": "773585870",
"telephone_number": "936-777-5630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14210 TX-150",
"city": "COLDSPRING",
"state": "TX",
"postal_code": "77331",
"telephone_number": "936-653-1179"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIDES",
"first_name": "RENEE",
"middle_name": "LEE",
"credential": "MA, LSSP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-10-29",
"last_updated": "2021-10-01",
"certification_date": "2021-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, School",
"state": "TX",
"license": "30497",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Coldspring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 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.