Organization
FRESH START PSYCHIATRIC CLINIC
Active
Organization
FRESH START PSYCHIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHIAUS SUIRE CNS (OWNER)
(512) 952-0295
Entity
Organization
Contact information
Practice address
11455 FALLBROOK DR STE 201, HOUSTON, TX 77065-4267
(337) 223-9487
(888) 511-5650
Mailing address
1921 DULLES DR, LAFAYETTE, LA 70506-2716
(373) 223-9487
(888) 511-5650
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029807
—
LA
01
—
11813129
CAQH
—
01
—
418846
MHN
LA
01
—
600712760
MAGELLAN
LA
01
—
MD.201514
MD LICENSE
LA
01
—
NJ2611
BCBS#
NJ
Enumeration date
07/16/2020
Last updated
07/16/2021
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