Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 25476 | TX |
Y | 103TC0700X | Clinical Psychologist | 25476 | TX |
N | 103G00000X | Clinical Psychologist | 25476 | TX |
N | 103TC0700X | Clinical Psychologist | 25476 | TX |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 25476 | TX |
N | 103TM1800X | Intellectual & Developmental Disabilities | 25476 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 25476 | TX |
NPI | 1255499356 |
---|---|
Provider Name | Dr. Peter L Stavinoha |
First Address | Houston, TX 77210-4439 |
Second Address | Houston, TX 77030-4000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 18/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
039133606 | (05) | TX |
039133607 | CSHCN TPI (01) | TX |