Unknown Individual – Clinical Psychologist, NPI 1083835417

Unknown Individual is a healthcare provider. based in Longview, Texas. specializing in Clinical Psychologist. They hold a License No. 24806 (TX). The NPI Number for Unknown Individual is 1083835417

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1083835417
Phone
(903) 238-9553
Address
1508 W FAIRMONT ST
Deactivation Date
15 April 2021
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1508, West Fairmont Street, Toler Place, Greggton, Longview, Gregg County, Texas, 75604, United States

    SUITE C

    LONGVIEW, TX 756046303

    Phone: (903) 238-9553

    Fax: (903) 291-8709

    Type: Location

  • Longview Post Office, Hillside Road, Longview Shops, Stockbridge Village, Page Moss, Huyton, Liverpool, Liverpool City Region, England, L36 8BJ, United Kingdom

    LONGVIEW, TX 756089062

    Phone: (903) 238-9553

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

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Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

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Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 75604)

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Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1083835417?
NPI 1083835417 belongs to Unknown Individual; compare other details if you need extra assurance.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Clinical Psychologist. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Longview?
Public fields place Unknown Individual around Longview, Texas. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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