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General NPI Number Information
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NPI Number | 1942349451
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Entity Type | Individual
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Provider Name | CORWIN BOAKE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 03/30/2013
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Provider Practice Location Address
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Address Line | 1333 MOURSUND ST
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City | HOUSTON
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State | TX
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Zip | 77030-3405
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Country | US
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Telephone | 713-799-6990
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Fax | 713-799-7049
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Provider Business Mailing Address
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Address Line | 1333 MOURSUND ST
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City | HOUSTON
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State | TX
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Zip | 77030-3405
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Country | US
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Telephone | 713-799-6990
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Fax | 713-799-7049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 23147
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 23147
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | MP.0661
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License Number State | LA
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