Bodden, Jack L.
Bodden, Jack L. is an individual health care provider with primary practice located at 1600 University Dr E , College Station TX 77840-2642. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Bodden, Jack L. can be contacted via phone (409) 691-3300.Contact Information
Primary practice address
1600 University Dr E
College Station TX 77840-2642
Phone: (409) 691-3300
Fax:
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 20473 | Texas |
Profile Details
NPI number | 1649230814 |
---|---|
LBN Legal business name | Bodden, Jack L. |
Credentials | P.H.D. |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Mar 23rd, 2006 |
Last updated | Jul 10th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1649230814 | NPPES |
Texas | Other | 81078P | BLUE SHIELD |
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