Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 10877 | TX |
NPI | 1104590322 |
---|---|
Provider Name | Mr. Marvin Edson Hughes III |
First Address | Houston, TX 77098-1854 |
Second Address | Houston, TX 77098-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2021 |
Last Update Date | 02/08/2021 |