Provider Demographics
NPI:1306946785
Name:ATWAL, MOHINDER SINGH (PHD NPH)
Entity type:Individual
Prefix:MR
First Name:MOHINDER
Middle Name:SINGH
Last Name:ATWAL
Suffix:
Gender:M
Credentials:PHD NPH
Other - Prefix:MR
Other - First Name:MOE
Other - Middle Name:SINGH
Other - Last Name:ATWAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD NPH
Mailing Address - Street 1:5750 BALCONES DR
Mailing Address - Street 2:#107
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4268
Mailing Address - Country:US
Mailing Address - Phone:512-459-1774
Mailing Address - Fax:512-454-0287
Practice Address - Street 1:5750 BALCONES DR
Practice Address - Street 2:#107
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4268
Practice Address - Country:US
Practice Address - Phone:512-459-1774
Practice Address - Fax:512-454-0287
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22609103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00JD62Medicare ID - Type Unspecified