Pediatric Behavioral Specialist of East Texas, LLP

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

G1593 Issued in TX

Legal business name

PEDIATRIC BEHAVIORAL SPECIALIST OF EAST TEXAS, LLP

Practice address

205 Gene Samford Dr
Lufkin, TX 75904-3359

Phone

(936) 634-2214

Fax

(936) 639-9660

NPI assigned

Mar 20, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey Glass, M.D

Title

Dr/Owner

Phone

(936) 634-2214

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1588906341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 GENE SAMFORD DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 GENE SAMFORD DR",
            "city": "LUFKIN",
            "state": "TX",
            "postal_code": "759043359",
            "telephone_number": "936-634-2214",
            "fax_number": "936-639-9660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC BEHAVIORAL SPECIALIST OF EAST TEXAS, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "DR/OWNER",
        "authorized_official_telephone_number": "936-634-2214",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "G1593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathy George Pavlic
• Justin Daniel Pavlic, FNP, RN
• Katie Pavlic, LPC
• Jenifer Paypa
• Prasad K Peddu, M.D.
• Jennifer Peikert, M.S. CCC/SLP
• Jaclyn Pena
• Lauren Elaine Penn, DPT, PT
• Hilario Perez Jr., PHARMD
• Quang Pham, D.O.

• Child & Adolescent Psychiatry Physician in Lufkin, TX
• Providers in Lufkin, TX by specialty
• Child & Adolescent Psychiatry Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; 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.