Basic Information
| Provider Information | |||||||||
| NPI: | 1538348297 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ATCG LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | AMERICAN THERAPY CONSULTING GROUP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 14673 | ||||||||
| Address2: | |||||||||
| City: | HUMBLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773474673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812600821 | ||||||||
| FaxNumber: | 2812600352 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 E HERITAGE DR | ||||||||
| Address2: | |||||||||
| City: | FRIENDSWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775463830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812600821 | ||||||||
| FaxNumber: | 2812600352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2007 | ||||||||
| LastUpdateDate: | 04/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | JOHNS | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2812600821 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 156168006 | 05 | TX | MEDICAID |