Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 33327 | TX |
Y | 103TC0700X | Clinical Psychologist | 33327 | TX |
NPI | 1013002336 |
---|---|
Provider Name | Dr. Scott Camburn Storm |
First Address | Del Rio, TX 78843-5242 |
Second Address | Del Rio, TX 78843-5242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 13/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11766955 | CAQH (01) | TX |
2114-03502 | (05) | TX |