Provider Demographics
NPI:1326155326
Name:HIRSCH, VICTOR NOLAN (PH D)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:NOLAN
Last Name:HIRSCH
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E MAIN ST
Mailing Address - Street 2:STE 100
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-2495
Mailing Address - Country:US
Mailing Address - Phone:281-332-3852
Mailing Address - Fax:281-557-7518
Practice Address - Street 1:1025 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-2483
Practice Address - Country:US
Practice Address - Phone:281-332-3852
Practice Address - Fax:281-332-3852
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22870103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033476501Medicaid
TX033476501Medicaid