Individual
MANUEL HARTY EDQUIST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
517 LAKE DR, CHINA SPRING, TX 76633-2631
(254) 315-5761
Mailing address
517 LAKE DR, CHINA SPRING, TX 76633-2631
(254) 315-5761
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
21060
TX
Other
Enumeration date
02/13/2006
Last updated
05/16/2011
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