Active NPI
Dessirae Boulware, PSYD
- Clinical Psychologist
- Houston, TX
National Provider Identifier
1376827519
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 38405
- Practice address
- 3833 Dunlavy Street
Houston, TX 77006-4769 - Phone
- (281) 728-0766
- NPI assigned
- Oct 6, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY28641 | CA | |
| Clinical Psychologist | 103TC0700X | 38405 | TX | Primary |
Addresses
Primary practice location
3833 Dunlavy Street
Houston, TX 77006-4769
Mailing address
PO Box 66211
Houston, TX 77266-6211
Phone (281) 728-0766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38405 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317859200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601510400000",
"number": "1376827519",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 66211",
"city": "HOUSTON",
"state": "TX",
"postal_code": "772666211",
"telephone_number": "281-728-0766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3833 DUNLAVY STREET",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770064769",
"telephone_number": "281-728-0766"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULWARE",
"first_name": "DESSIRAE",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-06",
"last_updated": "2020-10-01",
"certification_date": "2020-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY28641",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "38405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.