Provider Demographics
NPI:1659370849
Name:SABINE, DAVID M (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SABINE
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:PO BOX 4169
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-0169
Mailing Address - Country:US
Mailing Address - Phone:940-228-7989
Mailing Address - Fax:940-720-0018
Practice Address - Street 1:1708 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6110
Practice Address - Country:US
Practice Address - Phone:940-228-7989
Practice Address - Fax:940-720-0018
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25041103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114618OtherSUPERIOR
TX115537601Medicaid
TX121125OtherVALUEOPTIONS
TX130445OtherMHN
OK100841220BMedicaid
TX5052129OtherAETNA BEHAVIORAL HEALTH
TX00N17ROtherBLUE CROSS BLUE SHIELD
TX00N17ROtherBLUE CROSS BLUE SHIELD
TX115537601Medicaid
TX680008090Medicare PIN