THE CHILDREN'S ASSESSMENT CENTER FOUNDATION

Provider Demographics

• NPI: 1972543833
• Name: THE CHILDREN'S ASSESSMENT CENTER FOUNDATION
• Entity type: Organization
• Organization Name: THE CHILDREN'S ASSESSMENT CENTER FOUNDATION
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MRS
• Authorized Official - First Name: ELIZABETH
• Authorized Official - Last Name: RUNGE
• Authorized Official - Phone: 713-986-3485
• Mailing Address - Street 1: 2500 BOLSOVER
• Mailing Address - City: HOUSTON
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77005
• Mailing Address - Country: US
• Mailing Address - Phone: 713-986-3300
• Mailing Address - Fax: 713-986-3553
• Practice Address - Street 1: 2500 BOLSOVER
• Practice Address - City: HOUSTON
• Practice Address - State: TX
• Practice Address - Zip Code: 77005
• Practice Address - Country: US
• Practice Address - Phone: 713-986-3300
• Practice Address - Fax: 713-986-3553
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-06-08
• Last Update Date: 2013-10-23

Provider Licenses

State	License ID	Taxonomies
TX	18746	101YM0800X
TX	18911	101YM0800X
TX	11940	101YM0800X
TX	16863	101YM0800X
TX	31259	103TC0700X
TX	32425	103TC0700X
TX	24946	103TC0700X
TX	31778	103TC0700X
TX	26546	1041C0700X
TX	34824	1041C0700X
TX	29189	1041C0700X
TX	23018	1041C0700X
TX	22477	1041C0700X
TX	L7434	2084P0800X
TX	17862	101YM0800X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	2084P0800X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Psychiatry	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
TX	040686003	Medicaid
TX	171048501	Medicaid
TX	042323801	Medicaid
TX	152197301	Medicaid
TX	153993401	Medicaid
TX	040542501	Medicaid
TX	039998201	Medicaid
TX	00U18M	Medicaid
TX	171045101	Medicaid
TX	095737503	Medicaid
TX	177683301	Medicaid
TX	040247101	Medicaid
TX	151734401	Medicaid
TX	159606601	Medicaid
TX	171047701	Medicaid
TX	177067901	Medicaid