Provider Demographics
NPI:1285858910
Name:NEUBAUER, DERRICK (LPC,LPA)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:
Last Name:NEUBAUER
Suffix:
Gender:M
Credentials:LPC,LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 GALBRAITH AVE
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4107
Mailing Address - Country:US
Mailing Address - Phone:830-896-2211
Mailing Address - Fax:
Practice Address - Street 1:400 GALBRAITH AVE
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4107
Practice Address - Country:US
Practice Address - Phone:830-896-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13163101YM0800X
TX14606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1479503-01Medicaid