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DR. MARK C. WILDE PSY.D.

Clinical Neuropsychologist

Houston, Texas

Provider NPI: 1730148925

Provider Information:
DR. MARK C. WILDE PSY.D.
Gender: M
Not Sole Proprietor

Practice Location:
13300 HARGRAVE RD SUITE 505 HOUSTON, TX 77070 US
Tel: 281-737-1167  Fax: 281-469-1460

Business Mailing Address:
13300 HARGRAVE RD SUITE 505 HOUSTON, TX 77070 US
Tel: 281-737-1167  Fax: 281-469-1460

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
TX25025
Y2084N0600XPhysicians
Psychiatry & Neurology
TX25025

Other Provider Identifiers:

IssuerNumberStateType
BCBS89680ATX01
102648606TX05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







CLINICAL NEUROPSYCHOLOGIST JOBS TX - Page 1



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