Provider Demographics
NPI:1376673400
Name:DORSEY, NICOLE B (PHD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:B
Last Name:DORSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7410 E SUDDLEY CASTLE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3535
Mailing Address - Country:US
Mailing Address - Phone:832-545-5498
Mailing Address - Fax:
Practice Address - Street 1:7410 E SUDDLEY CASTLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3535
Practice Address - Country:US
Practice Address - Phone:832-545-5498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX052707901Medicaid
TX052707901Medicaid