Provider Demographics
NPI:1639379217
Name:DAINAS, ROCHELLE S (PHD)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:S
Last Name:DAINAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 5TH ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3678
Mailing Address - Country:US
Mailing Address - Phone:830-285-0001
Mailing Address - Fax:
Practice Address - Street 1:123 COMMERCE ST
Practice Address - Street 2:SUITE A
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4950
Practice Address - Country:US
Practice Address - Phone:830-285-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33119103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1920704-01Medicaid
TX613134Medicare UPIN