Provider Demographics
NPI:1720097959
Name:QUIJANO, WALTER Y (PHD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:Y
Last Name:QUIJANO
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 1:901 N THOMPSON ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2554
Mailing Address - Country:US
Mailing Address - Phone:936-539-2226
Mailing Address - Fax:936-788-5897
Practice Address - Street 1:901 N THOMPSON ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2554
Practice Address - Country:US
Practice Address - Phone:936-539-2226
Practice Address - Fax:936-788-5897
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21679103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N55TMedicare ID - Type UnspecifiedGROUP NUMBER
TX81432PMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE