Provider Demographics
NPI:1194763599
Name:KOTIK-HARPER, DOREEN (PHD)
Entity type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:KOTIK-HARPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DOREEN
Other - Middle Name:
Other - Last Name:KOTIK-HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3400 BISSONNET ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2155
Mailing Address - Country:US
Mailing Address - Phone:713-594-0744
Mailing Address - Fax:713-668-6595
Practice Address - Street 1:14023 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3550
Practice Address - Country:US
Practice Address - Phone:281-325-4267
Practice Address - Fax:281-325-4262
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114449501Medicaid
TX80016PMedicare ID - Type Unspecified