Provider Demographics
NPI:1558342584
Name:HOGAN, MALAUNA CRIVENS (PHD)
Entity Type:Individual
Prefix:
First Name:MALAUNA
Middle Name:CRIVENS
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MALAUNA
Other - Middle Name:
Other - Last Name:CRIVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:131 MINT MARIGOLD DR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-1008
Mailing Address - Country:US
Mailing Address - Phone:214-298-1948
Mailing Address - Fax:
Practice Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 1702
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-0231
Practice Address - Country:US
Practice Address - Phone:469-812-8492
Practice Address - Fax:469-351-5874
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31747103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182674504Medicaid
TX87077AOtherBCBS
TX8J1245Medicare PIN
TX8J1244Medicare PIN
TX182674504Medicaid
TX86964AMedicare ID - Type Unspecified