Healthcare Provider Details

I. General information

NPI: 1053059618
Provider Name (Legal Business Name): PRICE PROCTOR & ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11882 GREENVILLE AVE STE 107
DALLAS TX
75243-3567
US

IV. Provider business mailing address

11882 GREENVILLE AVE STE 107
DALLAS TX
75243-3567
US

V. Phone/Fax

Practice location:
  • Phone: 972-644-8686
  • Fax:
Mailing address:
  • Phone: 972-644-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. RHANDA HOLDEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 972-644-8968