Provider Demographics
NPI:1114143054
Name:GENAC, DAVID STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:STEVEN
Last Name:GENAC
Suffix:
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 1:1712 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-1711
Mailing Address - Country:US
Mailing Address - Phone:713-899-3769
Mailing Address - Fax:
Practice Address - Street 1:1712 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-1711
Practice Address - Country:US
Practice Address - Phone:713-899-3769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31528103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling