Healthcare Provider Details

I. General information

NPI: 1407470404
Provider Name (Legal Business Name): NANCY WHELESS VREELAND PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY ELIZABETH WHELESS PSY.D.

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-1612
  • Fax:
Mailing address:
  • Phone: 214-857-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number38190
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: