Provider Demographics
NPI:1134168198
Name:BLOCK, ANDREW ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ROBERT
Last Name:BLOCK
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 262409
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75026-2409
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:
Practice Address - Street 1:6020 W PARKER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8171
Practice Address - Country:US
Practice Address - Phone:972-608-5000
Practice Address - Fax:972-608-5020
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-4306103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0362725-02Medicaid
TX00U10PMedicare UPIN
TX8G2817Medicare PIN