Provider Demographics
NPI:1073809315
Name:SOHN MCCORMICK, ANITA LUISA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:LUISA
Last Name:SOHN MCCORMICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:LUISA
Other - Last Name:SOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1318 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5215
Mailing Address - Country:US
Mailing Address - Phone:979-776-2872
Mailing Address - Fax:979-776-2872
Practice Address - Street 1:1318 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5215
Practice Address - Country:US
Practice Address - Phone:979-776-2872
Practice Address - Fax:979-776-2872
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35194103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist