Provider Demographics
NPI:1215019104
Name:MCGIRK, CACTUS ROBIN (PHD)
Entity Type:Individual
Prefix:
First Name:CACTUS
Middle Name:ROBIN
Last Name:MCGIRK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:C
Other - Middle Name:ROBIN
Other - Last Name:MCGIRK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2007 TEXOMA PKWY
Mailing Address - Street 2:SUITE 194
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090
Mailing Address - Country:US
Mailing Address - Phone:903-893-5344
Mailing Address - Fax:903-893-5344
Practice Address - Street 1:2007 TEXOMA PKWY
Practice Address - Street 2:SUITE 194
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090
Practice Address - Country:US
Practice Address - Phone:903-893-5344
Practice Address - Fax:903-893-5344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23018103T00000X
OK810103T00000X
TX30440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031678801Medicaid
TX031678801Medicaid