Individual
VIRGINIA N NIEBUHR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
301 UNIVERSITY BLVD, GALVESTON, TX 77555-5302
(409) 772-2222
Mailing address
301 UNIVERSITY BLVD, GALVESTON, TX 77555-5302
(409) 772-2222
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
2-2246
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620006276
RR MCR PTAN
TX
05
—
PO81018P8
—
TX
Enumeration date
10/18/2006
Last updated
01/15/2020
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