Organization
CLEARLAKE KIDS PSYCHIATRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE RUSSELL PA-C (OWNER)
(903) 918-3294
Entity
Organization
Contact information
Practice address
17226 MERCURY DR, SUITE 100, HOUSTON, TX 77058-2792
(281) 975-0600
Mailing address
17226 MERCURY DR, SUITE 100, HOUSTON, TX 77058-2792
(281) 975-0600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00473
TX
Other
Enumeration date
09/12/2016
Last updated
09/05/2017
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