Healthcare Provider Details

I. General information

NPI: 1497285043
Provider Name (Legal Business Name): ELIAS BARGHASH PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 12/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 MARKETPLACE DR
WACO TX
76711-2467
US

IV. Provider business mailing address

4242 MEDICAL DR STE 6300
SAN ANTONIO TX
78229-5606
US

V. Phone/Fax

Practice location:
  • Phone: 254-202-7300
  • Fax:
Mailing address:
  • Phone: 210-614-8400
  • Fax: 210-614-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: