Organization
GERIATRIC EVALUATION & MENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GERSTENHABER (MANAGER)
(512) 301-7200
Entity
Organization
Contact information
Practice address
4501 DUDMAR DR, AUSTIN, TX 78735-6913
(832) 448-2800
(832) 448-2801
Mailing address
12012 WICKCHESTER LN, SUITE 550, HOUSTON, TX 77079-1229
(832) 448-2800
(832) 448-2801
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ2516
RAILROAD MEDICARE
TX
Enumeration date
03/06/2008
Last updated
03/17/2008
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