MEDICARE: DR. CYNTHIA A PEVETO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	31077	TX

General Provider Information

NPI Number	:	1144399874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA A PEVETO PH.D.

Provider Business Mailing Address
First Line	:	3201 TEASLEY LN
Second Line	:	STE 303
City	:	DENTON
State	:	TX
Zip	:	76210-8302
Country	:	US
Telephone Number	:	940-383-8282
Fax Number	:	940-565-8170

Provider Business Practice Location Address
First Line	:	3201 TEASLEY LN
Second Line	:	STE 303
City	:	DENTON
State	:	TX
Zip	:	76210-8302
Country	:	US
Telephone Number	:	940-383-8282
Fax Number	:	940-565-8170

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	07/09/2007

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