Provider Demographics
NPI:1740672146
Name:BODIN, DAN
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:BODIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11211 KATY FWY
Mailing Address - Street 2:SUITE 620
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-2126
Mailing Address - Country:US
Mailing Address - Phone:832-962-4377
Mailing Address - Fax:832-532-9775
Practice Address - Street 1:11211 KATY FWY
Practice Address - Street 2:SUITE 620
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2126
Practice Address - Country:US
Practice Address - Phone:832-962-4377
Practice Address - Fax:832-532-9775
Is Sole Proprietor?:No
Enumeration Date:2015-02-23
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy