Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 22413 | CA |
N | 103T00000X | Psychologist | 22413 | CA |
Y | 102L00000X | Psychologist | 3-1090 | TX |
Y | 103T00000X | Psychologist | 3-1090 | TX |
N | 103G00000X | Clinical Psychologist | 1107 | LA |
N | 103TC0700X | Clinical Psychologist | 1107 | LA |
NPI | 1003067158 |
---|---|
Provider Name | Dr. Gregory Haden Andrews |
First Address | Brownwood, TX 76804-1267 |
Second Address | Brownwood, TX 76801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 10/08/2009 |