Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 24658 | TX |
N | 103TC0700X | Clinical Psychologist | 24658 | TX |
N | 103TS0200X | School Psychologist | 30078 | TX |
NPI | 1043368061 |
---|---|
Provider Name | Dr. Bradley Frank |
First Address | Bellaire, TX 77401-3500 |
Second Address | Bellaire, TX 77401-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L87A | BLUE CROSS BLUE SHIELD (01) | TX |