Provider Demographics
NPI:1477665735
Name:COUSINS, PETER C (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:C
Last Name:COUSINS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 KIRBY DR
Mailing Address - Street 2:SUITE 596
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3900
Mailing Address - Country:US
Mailing Address - Phone:713-523-5778
Mailing Address - Fax:713-456-2538
Practice Address - Street 1:3000 RICHMOND AVE
Practice Address - Street 2:SUITE 425
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3188
Practice Address - Country:US
Practice Address - Phone:713-523-5778
Practice Address - Fax:713-456-2538
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23052103T00000X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034174501Medicaid
TX034174501Medicaid