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Individual

MISSID GEORGE GHANEM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSYD

Contact information

Practice address
26515 OAKRIDGE DR, WOODLAND, TX 77380
(281) 367-0328
(281) 419-9753
Mailing address
26515 OAK RIDGE DR, THE WOODLANDS, TX 77380-1966
(281) 367-0328
(281) 419-9753

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
26864
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00Y917
MEDICARE GROUP P-TAN
TX
05
097011302
TX
Enumeration date
08/20/2006
Last updated
03/20/2015
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