Individual provider Active NPI

Holly Mull Teitsma, PH.D.

  • Counseling Psychologist
  • Houston, TX
National Provider Identifier
1770768178
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Counseling PsychologistTaxonomy code 103TC1900X
License
34500 Issued in TX
Practice address
16441 Space Center Blvd # C-100
Houston, TX 77058-2015
Phone
(281) 480-7554
Fax
(281) 480-4641
NPI assigned
Jan 3, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counseling Psychologist 103TC1900X 34500 TX Primary

Addresses

Primary practice location

16441 Space Center Blvd # C-100
Houston, TX 77058-2015

Mailing address

16441 Space Center Blvd # C-100
Houston, TX 77058-2015
Phone (281) 480-7554

Other names 1

  • Dr. Holly Beth Mull Former name

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
I20160927002975 TX Practitioner - Clinical Psychologist 1254628753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2004
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Carole and Ronald Krist Samaritan Counseling CenterGroup PAC ID 8325274152, 10 clinicians

Practice addresses (Care Compare)

16441 Space Ctr Blvd
Suite C100
Houston, TX 77058-2015
Phone (281) 480-7554

6363 Research Forest Dr
The Woodlands, TX 77381-6029
Phone (281) 480-7554

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34500TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Carole and Ronald Krist Samaritan Counseling Center Counseling CurrentSince Jul 5, 2016 Accepting new patients

Locations

17555 El Camino Real
Houston, TX 77058

16441 Space Center Blvd
#C100
Houston, TX 77058
Phone 28148075542743

6363 Research Forest Dr
The Woodlands, TX 77381
Phone 2814807554 ext. 2727

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": "1199318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1770768178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16441 SPACE CENTER BLVD # C-100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582015",
            "telephone_number": "281-480-7554",
            "fax_number": "281-480-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16441 SPACE CENTER BLVD # C-100",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770582015",
            "telephone_number": "281-480-7554",
            "fax_number": "281-480-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEITSMA",
        "first_name": "HOLLY",
        "middle_name": "MULL",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-03",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "TX",
            "license": "34500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HOLLY",
            "last_name": "MULL",
            "middle_name": "BETH",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.