Healthcare Provider Details

I. General information

NPI: 1023432481
Provider Name (Legal Business Name): DOCTHERESE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2014
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 FAIR MEADOWS DR
N RICHLND HLS TX
76182-7611
US

IV. Provider business mailing address

6812 FAIR MEADOWS DR
N RICHLND HLS TX
76182-7611
US

V. Phone/Fax

Practice location:
  • Phone: 817-228-6819
  • Fax: 866-801-2988
Mailing address:
  • Phone: 817-228-6819
  • Fax: 866-801-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number23197
License Number StateTX

VIII. Authorized Official

Name: DR. THERESE ADAMIEC
Title or Position: SOLE MEMBER
Credential: PH.D.
Phone: 817-228-6819