Healthcare Provider Details

I. General information

NPI: 1134731813
Provider Name (Legal Business Name): ON-SITE PSYCHOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2020
Last Update Date: 08/23/2020
Certification Date: 08/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 HEBRON PKWY STE 240
LEWISVILLE TX
75057-5122
US

IV. Provider business mailing address

751 HEBRON PKWY STE 240
LEWISVILLE TX
75057-5122
US

V. Phone/Fax

Practice location:
  • Phone: 469-825-0414
  • Fax: 888-835-2599
Mailing address:
  • Phone: 469-825-0414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY C JOHNSON
Title or Position: OWNER
Credential: PSY.D
Phone: 469-825-0414