Healthcare Provider Details

I. General information

NPI: 1104258292
Provider Name (Legal Business Name): NEGIN PAHLAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2013
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SCHOFIELD RD
FORT SAM HOUSTON TX
78234-7577
US

IV. Provider business mailing address

3100 SCHOFIELD RD
FORT SAM HOUSTON TX
78234-7577
US

V. Phone/Fax

Practice location:
  • Phone: 210-808-6798
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37363
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: