NPI age
19 years
Enumerated 2007-03-08
Across 652 active psychologist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 038966001 | |
| 01 (TX) | 4108749 | AETNA ID |
| 01 (TX) | 81618P | BLUE CROSS ID |
| 01 (TX) | 21998 | STATE LICENSE |
| 01 (TX) | OP21998 | WC ID |
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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