| Organization Name: | TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER |
| NPI Number: | 1003824038 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN M. WAGNER (MANAGING DIRECTOR) |
| Mailing Address: | 4801 Alberta Ave. El Paso |
| State: | TX US |
| Postal Code: | 79905 |
| Phone Number: | 9155457579 |
| Fax Number: | 9155458870 |
| NPI Enumeration Date: | 08/04/2006 |
| NPI Last Update Date: | 12/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC2200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical Child & Adolescent |
| Taxonomy Definition: | |