Provider Demographics
NPI:1255446043
Name:COSTA, DANIELA M (PHD)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:M
Last Name:COSTA
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 1:8603 BROADWAY ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-9765
Mailing Address - Country:US
Mailing Address - Phone:281-902-1050
Mailing Address - Fax:281-902-1051
Practice Address - Street 1:8603 BROADWAY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-9765
Practice Address - Country:US
Practice Address - Phone:281-902-1050
Practice Address - Fax:281-902-1051
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33763103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist