Healthcare Provider Details

I. General information

NPI: 1982234340
Provider Name (Legal Business Name): CIL PSYCHOLOGICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2020
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3740 N JOSEY LN STE 246
CARROLLTON TX
75007-2509
US

IV. Provider business mailing address

1079 W ROUND GROVE RD STE 300-350
LEWISVILLE TX
75067-7905
US

V. Phone/Fax

Practice location:
  • Phone: 972-523-0200
  • Fax:
Mailing address:
  • Phone: 972-523-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: CHERYL L INMON LONG
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 972-523-0200