Individual
DR. MARK C. WILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
13201 NORTHWEST FWY STE 668, HOUSTON, TX 77040-6237
(713) 487-5882
Mailing address
13300 HARGRAVE RD, SUITE 505, HOUSTON, TX 77070-4373
(281) 737-1167
(281) 469-1460
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
25025
TX
2084N0600X
Clinical Neurophysiology Physician
Primary
25025
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102648606
—
TX
01
—
89680A
BCBS
TX
Enumeration date
03/17/2006
Last updated
07/24/2026
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