Healthcare Provider Details

I. General information

NPI: 1578630364
Provider Name (Legal Business Name): EMILY ALINE FALLIS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 W JEFFERSON BLVD
DALLAS TX
75208-5087
US

IV. Provider business mailing address

PO BOX 11592
FORT WORTH TX
76110-0592
US

V. Phone/Fax

Practice location:
  • Phone: 214-941-1650
  • Fax: 214-941-8008
Mailing address:
  • Phone: 817-366-3577
  • Fax: 817-921-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number25143
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: