| Doctor Name: | MANUEL HARTY EDQUIST |
| NPI Number: | 1528032083 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 21060 |
| Business Practice Address: | 517 Lake Dr China Spring, TX - 766332631 |
| Business Phone Number: | 2543155761 |
| Business Fax Number: | |
| Mailing Address: | 517 Lake Dr, CHINA SPRING |
| State: | TX |
| Postal Code: | 766332631 |
| Phone Number: | 2543155761 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2006 |
| NPI Last Update Date: | 05/16/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 21060 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |