MEDICARE: DR. DENNIS SANTANA-VELAZQUEZ PH. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist
2	103TC0700X	Clinical Psychologist	5348	PR
3	103TC2200X	Clinical Child & Adolescent Psychologist
4	103TF0000X	Family Psychologist
5	103TH0004X	Health Psychologist
6	103TH0100X	Health Service Psychologist
7	103TP2701X	Group Psychotherapy Psychologist
8	103TA0700X	Adult Development & Aging Psychologist	38131	TX

General Provider Information

NPI Number	:	1821421207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS SANTANA-VELAZQUEZ PH. D.

Provider Business Mailing Address
First Line	:	5246 DOW RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6202
Country	:	US
Telephone Number	:	713-939-1229
Fax Number	:

Provider Business Practice Location Address
First Line	:	5246 DOW RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77040-6202
Country	:	US
Telephone Number	:	713-939-1229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2013
Last Update Date	:	04/03/2019

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