Jack L. Bodden is a Clinical in College Station, Texas. Jack L. Bodden practices all healthcare services and medical treatments related to Clinical. The NPI Number for Jack L. Bodden is 1649230814. The last update date is 2007-07-10.
Jack L. Bodden's current location address is 1600 University Dr E, College Station, Texas. You can contact this provider via phone number 4096913300. The mailing address for Jack L. Bodden is 1600 University Dr E, College Station, Texas. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Jack L. Bodden |
|---|---|
| Address | 1600 University Dr E, College Station, Texas |
| Phone Number | 4096913300 |
| Fax Number | |
| Sole Proprietor | N |
| Credentials | P.H.D. |
NPI Number Detail
| NPI Number | 1649230814 |
|---|---|
| Provider Enumeration Date | 2006-03-23 |
| Last Updated Date | 2007-07-10 |
Provider Mailing Address Detail
| Address | 1600 University Dr E |
|---|---|
| City | College Station |
| State | Texas (TX) |
| Post Code | 778402642 |
| Phone Number | 4096913300 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinical |
|---|---|
| Taxonomy | 103Tc0700X |
| Licence No | 20473 |
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Definition: A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 81078P | TX | BLUE SHIELD |
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What is the unique 10-digit identification code assigned to Jack L. Bodden by the Centers for Medicare & Medicaid Services?
The Jack L. Bodden has been issued the NPI (National Provider Identifier) 1649230814, which serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Where is the Jack L. Bodden located?
The Jack L. Bodden is located at 1600 University Dr E, College Station, TX 778402642.
What is Jack L. Bodden's specialized area of practice, and what is the corresponding taxonomy classification code for this field?
The Jack L. Bodden's specialized field of practice is Clinical, and the corresponding taxonomy code that categorizes this area of specialization is 103Tc0700X.
On what date did the Jack L. Bodden receive its 1649230814 assignment from the Centers for Medicare & Medicaid Services?
The Jack L. Bodden was assigned its 1649230814 by the Centers for Medicare & Medicaid Services on 2006-03-23.
When was the information regarding Jack L. Bodden most recently updated?
The details pertaining to the Jack L. Bodden, including its address, specialty, and other relevant information, were last refreshed on 2007-07-10.