Individual
CORWIN BOAKE
Active
Individual
CORWIN BOAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
23147
TX
103TC0700X
Clinical Psychologist
23147
TX
103TP0016X
Prescribing (Medical) Psychologist
MP.0661
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1625642
—
TX
Enumeration date
02/05/2007
Last updated
03/30/2013
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