Healthcare Provider Details

I. General information

NPI: 1801370184
Provider Name (Legal Business Name): PROFESSIONAL EXAM SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 E GRAUWYLER RD STE 107
IRVING TX
75061-3239
US

IV. Provider business mailing address

PO BOX 153068
IRVING TX
75015-3068
US

V. Phone/Fax

Practice location:
  • Phone: 972-659-1234
  • Fax: 972-223-2626
Mailing address:
  • Phone: 972-659-1235
  • Fax: 972-223-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA M ENNIS
Title or Position: OWNER
Credential:
Phone: 214-236-5131