Provider Demographics
NPI:1821158353
Name:HINOJOSA, MARIBEL R (PHD)
Entity Type:Individual
Prefix:
First Name:MARIBEL
Middle Name:R
Last Name:HINOJOSA
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 1:2172 CHESTNUT OAK CIR
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-4168
Mailing Address - Country:US
Mailing Address - Phone:979-324-7931
Mailing Address - Fax:979-232-2176
Practice Address - Street 1:750 WILLIAM D FITCH PKWY STE 520
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-7494
Practice Address - Country:US
Practice Address - Phone:979-335-9199
Practice Address - Fax:979-232-2176
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5038106H00000X
TX33162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0083QYOtherBC/BS OF TEXAS
TX149909703Medicaid
TX612701OtherMEDICARE