Provider Demographics
NPI:1386773620
Name:BAK, JOSEPH S (PHD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:S
Last Name:BAK
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 1:7887 SAN FELIPE ST
Mailing Address - Street 2:SUITE 248
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1620
Mailing Address - Country:US
Mailing Address - Phone:713-974-1985
Mailing Address - Fax:713-974-3081
Practice Address - Street 1:7887 SAN FELIPE ST
Practice Address - Street 2:SUITE 248
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1620
Practice Address - Country:US
Practice Address - Phone:713-974-1985
Practice Address - Fax:713-974-3081
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22095103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130128OtherMHN
TX013083OtherVALUE OPTIONS
TX00H56ROtherBLUE CROSS BLUE SHIELD
TX10771085OtherCAQH
TX013083OtherVALUE OPTIONS