Provider Demographics
NPI:1730121617
Name:PATRICK, STEVE WAYNE (PSYD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:WAYNE
Last Name:PATRICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 SPRING VALLEY
Mailing Address - Street 2:SUITE 511
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-3629
Mailing Address - Country:US
Mailing Address - Phone:972-934-1485
Mailing Address - Fax:972-934-1498
Practice Address - Street 1:4100 SPRING VALLEY
Practice Address - Street 2:SUITE 511
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-3629
Practice Address - Country:US
Practice Address - Phone:972-934-1485
Practice Address - Fax:972-934-1498
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical