Provider Demographics
NPI:1205044740
Name:TEXAS TECH UNIVERSITY PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:TEXAS TECH UNIVERSITY PSYCHOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:806-742-3737
Mailing Address - Street 1:PO BOX 42051
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79409-2051
Mailing Address - Country:US
Mailing Address - Phone:806-742-3737
Mailing Address - Fax:806-742-3799
Practice Address - Street 1:18TH STREET AND BOSTON AVENUE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79409
Practice Address - Country:US
Practice Address - Phone:806-742-3737
Practice Address - Fax:806-742-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25048103T00000X
TX23874103T00000X
TX23791103T00000X
TX32461103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0012KDOtherBLUE CROSS BLUE SHIELD
TX04238.4OtherINTERFACE EAP
TXTEXAS0004 TEXAS 0011OtherCOMP CARE FIRST CARE