Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 38371 | TX |
NPI | 1063183341 |
---|---|
Provider Name | Benjamin Spear |
First Address | College Station, TX 77845-4493 |
Second Address | College Station, TX 77845-4493 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2021 |
Last Update Date | 25/09/2021 |