Provider Demographics
NPI:1568510980
Name:MCGUIRE, DENNIS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:MCGUIRE
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 1:115 N DIXIE DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5903
Mailing Address - Country:US
Mailing Address - Phone:979-299-1590
Mailing Address - Fax:979-299-1783
Practice Address - Street 1:115 N DIXIE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5903
Practice Address - Country:US
Practice Address - Phone:979-299-1590
Practice Address - Fax:979-299-1783
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22817103TC0700X
TX723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G484OtherBLUECROSS BLUE SHIELD NO
TX0985012-02Medicaid
TX065912OtherVALUE OPTIONS NUMBER
TX10017029OtherAMERIGROUP NUMBER
TX570015OtherAETNA PROVIDER NUMBER
TX570015OtherAETNA PROVIDER NUMBER