Provider Demographics
NPI:1700894037
Name:DUBOIS, KEITH ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:ERIC
Last Name:DUBOIS
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 1:4444 CORONA DR
Mailing Address - Street 2:STE. 231
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4324
Mailing Address - Country:US
Mailing Address - Phone:361-225-3944
Mailing Address - Fax:361-225-3945
Practice Address - Street 1:4444 CORONA DR
Practice Address - Street 2:STE. 231
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4324
Practice Address - Country:US
Practice Address - Phone:361-225-3944
Practice Address - Fax:361-225-3945
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist