Provider Demographics
NPI: | 1003967993 |
---|---|
Name: | SAUER, GORDON CHENOWETH JR (PHD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | GORDON |
Middle Name: | CHENOWETH |
Last Name: | SAUER |
Suffix: | JR |
Gender: | M |
Credentials: | PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 3200 N MACARTHUR BLVD |
Mailing Address - Street 2: | SUITE 101 |
Mailing Address - City: | IRVING |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75062-4453 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-867-2497 |
Mailing Address - Fax: | 972-867-2497 |
Practice Address - Street 1: | 3200 N MACARTHUR BLVD |
Practice Address - Street 2: | SUITE 101 |
Practice Address - City: | IRVING |
Practice Address - State: | TX |
Practice Address - Zip Code: | 75062-4453 |
Practice Address - Country: | US |
Practice Address - Phone: | 972-867-2497 |
Practice Address - Fax: | 972-867-2497 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-01-16 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 22998 | 103G00000X, 103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TF0200X, 103TH0100X, 103TM1800X, 103TP2701X, 103TR0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
Not Answered | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
Not Answered | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
Not Answered | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
Not Answered | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
Not Answered | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
Not Answered | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
Not Answered | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
Not Answered | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
Not Answered | 103TH0100X | Behavioral Health & Social Service Providers | Psychologist | Health Service |
Not Answered | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
Not Answered | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
Not Answered | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 00A52L | Other | BCBS |