Southeast Texas Child Guidance Center, PLLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SOUTHEAST TEXAS CHILD GUIDANCE CENTER, PLLC

Practice address

3250 Medical Center Dr
Beaumont, TX 77701-4627

Phone

(409) 813-1765

Fax

(409) 813-1875

NPI assigned

Dec 16, 2011

Last updated

May 5, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ravikumar Kanneganti, M.D.NPI 1679643191

Title

Owner/Director

Phone

(409) 813-1765

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ravikumar Kanneganti, M.D.

  • Psychiatry Physician
  • Beaumont, TX
  • NPI 1679643191
  Medicare reassignment NPD Authorized official
• Juliana Ama Amuzu-Doe

  • Family Nurse Practitioner
  • Beaumont, TX
  • NPI 1245901388
  NPD (past)

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

{
    "created_epoch": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1430784000000",
    "number": "1861761017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 21313",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777201313",
            "telephone_number": "409-813-1765",
            "fax_number": "409-813-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 MEDICAL CENTER DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014627",
            "telephone_number": "409-813-1765",
            "fax_number": "409-813-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST TEXAS CHILD GUIDANCE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2015-05-05",
        "status": "A",
        "authorized_official_last_name": "KANNEGANTI",
        "authorized_official_first_name": "RAVIKUMAR",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "409-813-1765",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Emergency Physician Associates, P.a.
• Southeast Texas Anesthesia LLP
• Southeast Texas Assisting, Inc.
• Southeast Texas Bariatric Center, LLC (Southeast Texas Bariatric Center)
• Southeast Texas Cardiology Associates II LLP
• Southeast Texas Community Health Clinic
• Southeast Texas Counseling & Assessment Services, PLLC
• Southeast Texas Ear, Nose & Throat, LLP
• Southeast Texas EMS
• Southeast Texas Eye Specialists, PLLC (Eye Centers Optical)

• Mental Health Counselor in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Mental Health Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.