Provider Demographics
NPI:1659891679
Name:BOSTIC, DINAH
Entity Type:Individual
Prefix:
First Name:DINAH
Middle Name:
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LOOP W STE 340
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2606
Mailing Address - Country:US
Mailing Address - Phone:832-830-8662
Mailing Address - Fax:713-714-8627
Practice Address - Street 1:2600 S LOOP W STE 340
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2606
Practice Address - Country:US
Practice Address - Phone:832-830-8662
Practice Address - Fax:713-714-8627
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77813101Y00000X
TN3777101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor